title: Cervical cerclage in delayed interval delivery in a multifetal pregnancy: a review of seven case series.
abstract: OBJECTIVE
  To examine whether cervical cerclage after the first delivery prolongs the inter-delivery interval in delayed interval deliveries.
  
  
  METHODS
  We identified 66 case reports and case series of delayed interval delivery published between 1880 and 2002. We selected seven case series that identified all cases of delayed interval delivery in their institutions during a specified period.
  
  
  RESULTS
  Despite routine use of broad-spectrum prophylactic antibiotics, the average incidence of clinical intrauterine infection after the first delivery was 36% (95% confidence interval (CI): 26-46%). The incidence of maternal sepsis was 4.9% (95% CI: 0.2-9.6%). Studies in which cerclage was infrequently used reported a shorter inter-delivery interval compared to studies where cerclage was used in all cases (median is equal to 9 days versus 26 days, respectively, P<0.001) despite similar gestational ages at the first delivery, types of antibiotics, tocolytics, and incidence of infection. After controlling for other factors, the use of cerclage did not significantly increase the risk of intrauterine infection (adjusted relative risk=1.1, 95% CI: 0.4-3.5).
  
  
  CONCLUSIONS
  Cervical cerclage after the first delivery is associated with a longer inter-delivery interval without increasing the risk of intrauterine infection.
authors.affiliation: Epidemiology Branch, National Institute of Child Health and Human Development, National Institutes of Health, NIH Building 6100, Room 7B03, Bethesda, MD 20892, USA. jim_zhang@nih.gov
authors.forename: Jun
authors.initials: J
authors.lastname: Zhang
authors.forename: Courtney D
authors.initials: CD
authors.lastname: Johnson
authors.forename: Matthew
authors.initials: M
authors.lastname: Hoffman
mesh_terms: D023802:Cerclage, Cervical / Q000009:adverse effects; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D007239:Infections / Q000453:epidemiology; D016239:MEDLINE; D007752:Obstetric Labor, Premature / Q000209:etiology / Q000517:prevention & control; D011247:Pregnancy; D011272:Pregnancy, Multiple; D013997:Time Factors; D014310:Triplets; D014427:Twins; D002581:Uterine Cervical Incompetence / Q000150:complications / Q000628:therapy; D014591:Uterine Diseases / Q000453:epidemiology