A randomized controlled trial of cervical scanning vs history to determine cerclage in women at high risk of preterm birth (CIRCLE trial).
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.
Simcox
Rachael
R
Division of Reproduction and Endocrinology, Maternal and Fetal Research Unit, St. Thomas' Hospital, King's College London, London, UK.
Seed
Paul T
PT
Bennett
Phillip
P
Teoh
T G
TG
Poston
Lucilla
L
Shennan
Andrew H
AH
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