Cervical cerclage placed before 14 weeks gestation in women with one previous midtrimester loss: A population-based cohort study.
Aust N Z J Obstet Gynaecol
; 57(6): 593-598, 2017 Dec.
Article
en En
| MEDLINE
| ID: mdl-28508414
ABSTRACT
BACKGROUND:
Cervical cerclage is used in an attempt to reduce recurrence risk of preterm birth, but evidence for use is limited.AIMS:
To compare pregnancy outcomes among women with a single previous midtrimester delivery when managed with or without a cervical cerclage. MATERIALS ANDMETHODS:
Population-based cohort study of all women in New South Wales, Australia with a singleton pregnancy ending in birth/miscarriage ≥14 and <28 weeks, between 2003 and 2011. Modified Poisson regression was used to compare outcomes in the next subsequent pregnancy, for women with a cerclage inserted <14 weeks, and those without cerclage. The primary outcome was gestational age <37 weeks at birth/miscarriage in the next pregnancy. Secondary outcomes included maternal morbidity, preterm prelabour rupture of membranes (PPROM), stillbirth/neonatal death and composite neonatal morbidity for liveborn infants ≥28 weeks. Adjusted risk ratios (ARR) and 95% confidence intervals (CI) were determined.RESULTS:
Five thousand, six hundred and ninety-eight births/miscarriages were potential index deliveries. Of these, 2175 women had an eligible subsequent pregnancy 108 received cerclage at <14 weeks gestation, 2067 did not. Women with cerclage were significantly more likely to deliver <37 weeks than those without (39.8% vs 19.3%, ARR 1.92, 95% CI 1.48-2.48), and had increased risks of PPROM (ARR 4.38, 95% CI 2.62-7.32) and stillbirth/neonatal death (ARR 2.20, 95% CI 1.02-4.73). Following cerclage, liveborn infants ≥28 weeks had double the risk of severe morbidity (ARR 2.54, 95% CI 1.55-4.16).CONCLUSIONS:
In women with a single previous midtrimester delivery, cervical cerclage <14 weeks gestation in subsequent pregnancy was associated with worse pregnancy outcomes.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
2_ODS3
/
7_ODS3_muertes_prevenibles_nacidos_ninos
Problema de salud:
2_mortalidade_materna
/
2_muertes_prevenibles
/
7_neonatal_care_health
Asunto principal:
Aborto Espontáneo
/
Cerclaje Cervical
/
Nacimiento Prematuro
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Adult
/
Female
/
Humans
/
Newborn
/
Pregnancy
País/Región como asunto:
Oceania
Idioma:
En
Revista:
Aust N Z J Obstet Gynaecol
Año:
2017
Tipo del documento:
Article
País de afiliación:
Australia