title: Cervical cerclage: one stitch or two?
abstract: OBJECTIVE
  We sought to determine whether routine placement of a second stitch at the time of cervical cerclage improves its efficacy.
  
  
  METHODS
  This is a retrospective cohort study of patients who had cervical cerclage placement at a single institution. Operative reports, ultrasound images, and delivery records were reviewed. Pregnancy outcomes of patients receiving a two-stitch cerclage were compared with those who received a one-stitch cerclage, with a primary outcome of spontaneous preterm delivery at <35 weeks' gestation. Univariable, multivariable, and Kaplan-Meier survival analyses were performed.
  
  
  RESULTS
  Of 146 patients, 63 had two stitches and 83 had one. Baseline characteristics and indications for cerclage were similar except for differences in history of prior cerclage and multiple gestations. The two-stitch approach was associated with a greater median cerclage height (20 mm versus 17 mm, p = 0.008), but there was no difference in spontaneous preterm delivery at <35 weeks' gestation (47.6% versus 41.0%, adjusted odds ratio 1.22, p = 0.630).
  
  
  CONCLUSIONS
  A two-stitch approach to cervical cerclage increases cerclage height, but may not improve efficacy.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, MO, USA. mcnamaraj@wudosis.wustl.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Park
authors.forename: Methodius G
authors.initials: MG
authors.lastname: Tuuli
authors.forename: Melissa
authors.initials: M
authors.lastname: Wong
authors.forename: Jeanine F
authors.initials: JF
authors.lastname: Carbone
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Ismail
authors.forename: George A
authors.initials: GA
authors.lastname: Macones
authors.forename: Anthony O
authors.initials: AO
authors.lastname: Odibo
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007752:Obstetric Labor, Premature / Q000601:surgery*; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000517:prevention & control*; D012189:Retrospective Studies; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000601:surgery*