Comparison of success and morbidity in cervical cerclage procedures.
A review of 251 cervical cerclage procedures in 205 women over a 7.5-year period was conducted to compare the success rate and morbidity of the Shirodkar and McDonald techniques. Fetal survival rate was 19% before 139 elective McDonald operations and 20% before 63 elective Shirodkar procedures. Fetal survival was 78% after elective McDonald operations and 87% after elective Shirodkar procedures, a difference that is not statistically significant (P > .05). Fetal survival rate was 53% after 30 emergency McDonald and 68% after 19 emergency Shirodkar procedures, a difference not statistically significant. Major postoperative morbidity occurred in 2.0% of the elective cerclage procedures, and acute chorioamnionitis accounted for half the complications (1.2%). Mean blood loss was 30 ml with McDonald operations and 44 ml with Shirodkar procedures; the maximum blood loss of 150 ml occurred in 2 emergency operations. Cervical laceration at parturition occurred more often with Shirodkar (11%) or McDonald (14%) procedures than with the 55,688 other deliveries (2.18%) during the 7.5-year study period (P < .001). Cervical scarring and elective cesarean section significantly (P < .025) increased the cesarean section rate to 16% after McDonald procedures and 25% after Shirodkar procedures.
D002584:Cervix Uteri / Q000601:surgery*; D002585:Cesarean Section; D005260:Female; D005313:Fetal Death; D005328:Fetal Viability; D006801:Humans; D008722:Methods; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011372:Progestins / Q000008:administration & dosage; D012189:Retrospective Studies; D013536:Suture Techniques; D002581:Uterine Cervical Incompetence / Q000601:surgery*
D011372:Progestins