title: Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with short cervical length.
abstract: The efficacy of Shirodkar cerclage was compared with that of the McDonald procedure for the prevention of preterm birth (PTB) in women with a short cervix. Secondary analysis using data from all published randomized trials including women with a short cervical length (CL) was performed comparing the use of Shirodkar versus McDonald sutures. Analysis was limited to singletons with short CL on transvaginal ultrasound. The primary outcome measure was PTB < 33 weeks. Statistical analysis was performed using bivariate and multivariable techniques. From 607 women randomly assigned in the study, 277 met our inclusion criteria; 127 received Shirodkar and 150 women received McDonald sutures. The mean ( +/- standard deviation) gestational age at delivery was 35.0 +/- 5.3 versus 36.3 +/- 4.7 for the Shirodkar versus McDonald groups, respectively ( p< 0.02). PTB < 33 weeks was seen in 61 (22%) of 277 women; 26 (20%) of 127 in the Shirodkar and 35 (23%) of 150 in the McDonald groups, respectively (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.5 to 1.6). On adjusting for confounders using logistic regression modeling, no significant difference in PTB < 33 weeks was found between the two groups (OR, 0.55; 95% CI, 0.2 to 1.3). In women with short cervical length randomly assigned to receiving cerclage, no significant difference in prevention of PTB was observed using Shirodkar or McDonald's procedures.
authors.affiliation: Department of Obstetrics and Gynecology, Washington University Medical Center, St. Louis, Missouri, USA.
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
authors.forename: Meekai S
authors.initials: MS
authors.lastname: To
authors.forename: Orion A
authors.initials: OA
authors.lastname: Rust
authors.forename: Sietske M
authors.initials: SM
authors.lastname: Althuisius
authors.forename: Kypros H
authors.initials: KH
authors.lastname: Nicolaides
mesh_terms: D000293:Adolescent; D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000473:pathology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*