Cervical occlusion in women with cervical insufficiency: protocol for a randomised, controlled trial with cerclage, with and without cervical occlusion.
OBJECTIVE
To evaluate the effect of double cerclage compared with a single cerclage.


METHODS
Randomised, controlled multicentre trial.


METHODS
Ten different countries are participating with both secondary and tertiary centres. The countries participating are Denmark, Sweden, Germany, United Kingdom, Spain, South Africa, Australia and India. This gives both a broad spectrum of diversity global and local. We expect a total of 242 women enrolled per year.


METHODS
Prophylactic study: 1. History of cervical incompetence/insufficiency. (Delivery 15 to <36 weeks.) 2. Congenital short cervix (secondary to maternal administration of diethyl stilbestrol) or traumatic/surgical damage rendering the vaginal approach difficult (e.g. conisation). 3. Cervical suture applied in previous pregnancy, successful outcome. 4. Previous failed cerclage. Therapeutic study: 5. Secondary cerclage: Short cervix, without the membranes being exposed to the vagina. 6. Tertiary cerclage: Short cervix, membranes exposed to the vagina. Observational study: Eligible women who refuse to be randomised will participate in an observational study. 7. Repeat/requested cervical occlusion.


METHODS
The women will be randomised between a single (vaginal or abdominal) and a double cerclage. The cervical cerclage (McDonald or Shirodkar) as well as the abdominal suture will be performed with the same material and technique normally used by the participating department. Those randomised to the double cerclage will have their external os closed with a continuous nylon 2-0/3-0 suture, in addition to the standard single cerclage. Local guidelines concerning antibiotics, Heparin, bed rest, tocolytics etc. are followed and recorded in the follow-up form.


METHODS
Primary endpoint is take home baby rate. The secondary endpoints are gestational age at delivery, incidence of preterm birth (<34+0 days) and number of days in neonatal unit.
Secher
N J
NJ
Department of Obstetrics and Gynecology, Copenhagen University Hospital, Hvidovre, Denmark. njsecher@dadlnet.dk
McCormack
C D
CD
Weber
T
T
Hein
M
M
Helmig
R B
RB
D023802:Cerclage, Cervical / Q000379:methods*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D012086:Reoperation; D013536:Suture Techniques; D002581:Uterine Cervical Incompetence / Q000601:surgery*