title: Comparison of two methods of cervical cerclage by ultrasound cervical measurement.
abstract: OBJECTIVE
  To compare the effects of cerclage performed with a modified Shirodkar procedure or with McDonald's technique using transvaginal ultrasound measurement of the distance between the external os and the suture.
  
  
  METHODS
  We performed a retrospective study of all patients who underwent a prophylactic cerclage with either the modified Shirodkar procedure or the McDonald's technique over a 3-year period. Physicians chose the cerclage technique according to their own preferences. Transvaginal ultrasound examination of the cervix was performed 2 weeks after the cerclage to measure its functional length and the distance between the external os and the cerclage.
  
  
  RESULTS
  During the study period, 14 patients had a cerclage with the modified Shirodkar procedure and 19 patients with the McDonald's technique. Twelve of these 33 patients (36.4%) delivered before 37 weeks. The obstetric characteristics of the patients in both groups were similar. There were no significant differences between the Shirodkar and McDonald groups as to the functional cervical length before (31.3 +/- 8.7 vs. 35.6 +/- 9.7 mm, respectively) or after (37.0 +/- 7.3 vs. 36.1 +/- 7.9 mm) cerclage, the distance between the external os and cerclage (16.7 +/- 3.8 vs. 14.0 +/- 5.2 mm), or the number of deliveries before 32 (0 vs. 2) and 34 (1 vs. 3) weeks.
  
  
  CONCLUSIONS
  The anterior colpotomy of the Shirodkar procedure increased the distance between the external os and the cerclage by a mean of 2.7 mm. This slight gain does not justify exposing the patient to the risks related to this procedure. When cerclage is necessary, McDonald's technique seems preferable.
authors.affiliation: Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Versailles-St Quentin University, Poissy, France.
authors.forename: P
authors.initials: P
authors.lastname: Rozenberg
authors.forename: M V
authors.initials: MV
authors.lastname: Sénat
authors.forename: A
authors.initials: A
authors.lastname: Gillet
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014463:Ultrasonography