Objective: To compare the efficacy of cerclage and no cerclage for the treatment of women at high risk for preterm delivery.
•Design: Randomized clinical trial
Setting: King Khalid Military City Hospital
Participants: Seventy asymptomatic singleton pregnant women with risk factors for preterm delivery and ultrasonographic evidence of preterm dilatation of the internal os between 14-24 weeks' gestation.
Methods: Thirty-six women had a McDonald cerclage (cerclage group) and 34 women received no cerclage (no cerclage group). After treatment each patient was followed up as an outpatient with bed rest and weekly ultrasonographic evaluation of the cervix. In the no-cerclage group, rescue cerclage was inserted if the internal os continued to dilate up to 24 weeks' gestation. Three in the cerclage group and two in the no-cerclage group were lost to follow-up.
Results: Both groups were comparable for demographic characteristics, risk factors for preterm delivery and transvaginal ultrasonographic cervical length and funneling. No significant difference was found between the cerclage group and the no-cerclage group in preteen delivery at < 34 weeks' gestation (9/33 vs 8/32 respectively) and neonatal survival (29/33 vs 29/32 respectively). The frequency of admission of infants to the neonatal intensive care unit was not affected by cerclage.
Conclusion: This trial found no benefit on pregnancy outcome of treatment with cervical cerclage in women identified to be at high risk for preterm delivery. |
