title: Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis.
abstract: OBJECTIVE
  To estimate if cerclage prevents preterm birth and perinatal mortality and morbidity in women with previous preterm birth, singleton gestation, and short cervical length in a meta-analysis of randomized trials.
  
  
  METHODS
  MEDLINE, PUBMED, EMBASE, and the Cochrane Library were searched using the terms "cerclage," "short cervix," "ultrasound," and "randomized trial."
  
  
  METHODS
  We included randomized trials of cerclage in women with short cervical length on transvaginal ultrasonography, limiting the analysis to women with previous spontaneous preterm birth and singleton gestation.
  
  
  RESULTS
  Patient-level data abstraction and analysis were accomplished by two independent investigators. Five trials met inclusion criteria. In women with a singleton gestation, previous spontaneous preterm birth, and cervical length less than 25 mm before 24 weeks of gestation, preterm birth before 35 weeks of gestation was 28.4% (71/250) in the cerclage compared with 41.3% (105/254) in the no cerclage groups (relative risk 0.70, 95% confidence interval 0.55– 0.89). Cerclage also significantly reduced preterm birth before 37, 32, 28, and 24 weeks of gestation. Composite perinatal mortality and morbidity were significantly reduced (15.6% in cerclage compared with 24.8% in no cerclage groups; relative risk 0.64, 95% confidence interval 0.45– 0.91).
  
  
  CONCLUSIONS
  In women with previous spontaneous preterm birth, singleton gestation, and cervical length less than 25 mm, cerclage significantly prevents preterm birth and composite perinatal mortality and morbidity.
authors: From the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania; the Departments of Biostatistics and Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Alabama, Birmingham, Alabama; and the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Lehigh Valley Hospital and Health Network, Allentown, Pennsylvania.
authors: Vincenzo
authors: V
authors: Berghella
authors: Timothy J
authors: TJ
authors: Rafael
authors: Jeff M
authors: JM
authors: Szychowski
authors: Orion A
authors: OA
authors: Rust
authors: John
authors: J
authors: Owen
mesh_terms: D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention; D014463:Ultrasonography