Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis.
OBJECTIVE
The purpose of this study was to determine the effectiveness of cerclage for a shortened cervix on transvaginal ultrasound scanning in terms of the rates of preterm delivery and adverse neonatal and maternal outcomes.


METHODS
Pre-MEDLINE and MEDLINE, EMBASE, and the Cochrane Library were searched for human studies that compared cerclage placement to no cerclage on the basis of transvaginal ultrasound findings of a short cervix (< or =2.5 cm). Two authors independently determined eligibility and abstracted data. Meta-analyses were conducted when possible.


RESULTS
Thirty-five studies were reviewed; 6 studies were eligible and were included in the analysis. There was no statistically significant effect of cerclage on the rates of preterm delivery (<37, <34, <32, and <28 weeks of gestation), preterm labor, neonatal mortality or morbidity, gestational age at delivery, or time to delivery. Birth weight was significantly higher with than without cerclage (P=.004).


CONCLUSIONS
The available evidence does not support cerclage for a sonographically detected short cervix. A randomized controlled trial is needed to determine whether this intervention will reduce adverse neonatal outcomes.
Belej-Rak
Timea
T
Department of Obstetrics and Gynecology, Sunnybrook and Women's College Health Sciences Center, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
Okun
Nan
N
Windrim
Rory
R
Ross
Susan
S
Hannah
Mary E
ME
D000293:Adolescent; D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging* / Q000601:surgery*