title: A randomized controlled trial of cervical scanning vs history to determine cerclage in women at high risk of preterm birth (CIRCLE trial).
abstract: OBJECTIVE
  We sought to compare history-indicated placement of cervical cerclage based on history- vs ultrasound-indicated placement in women at risk of preterm birth.
  
  
  METHODS
  We conducted a randomized controlled trial of history-indicated cervical cerclage suture based on history (clinician preference) vs ultrasound (< 20 mm cervical length) indicated in women at increased risk.
  
  
  RESULTS
  The incidence of the primary outcome, preterm delivery between 24(+0) and 33(+6) weeks, was similar: 19/125 (15%) in the history-indicated group vs 18/122 (15%) in the ultrasound-indicated group (relative risk [RR], 0.97; 95% confidence interval [CI], 0.54-1.76). Those women randomized to the ultrasound-indicated arm were significantly more likely to receive a cerclage (32% vs 19%; RR, 1.66; 95% CI, 1.07-2.47) and progesterone (39% vs 25%; RR, 1.55; 95% CI, 1.06-2.25).
  
  
  CONCLUSIONS
  Screening women at high risk with cervical ultrasound to determine cerclage placement results in more intervention but similar outcome compared with history-indicated placement.
authors.affiliation: Division of Reproduction and Endocrinology, Maternal and Fetal Research Unit, St. Thomas' Hospital, King's College London, London, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Simcox
authors.forename: Paul T
authors.initials: PT
authors.lastname: Seed
authors.forename: Phillip
authors.initials: P
authors.lastname: Bennett
authors.forename: T G
authors.initials: TG
authors.lastname: Teoh
authors.forename: Lucilla
authors.initials: L
authors.lastname: Poston
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Shennan
mesh_terms: D000026:Abortion, Habitual; D000328:Adult; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D012307:Risk Factors; D014463:Ultrasonography