title: Ultrasound-indicated cerclage: Shirodkar vs. McDonald.
abstract: OBJECTIVE
  To compare the efficacy of Shirodkar to McDonald cerclage in patients with singleton pregnancies undergoing an ultrasound-indicated cerclage.
  
  
  METHODS
  Historical cohort of all patients with singleton pregnancies undergoing cerclage for the indication of a short cervix on ultrasound (ultrasound indicated) at one institution in 2005-2010. We compared outcomes based on cerclage type, Shirodkar or McDonald. Outcome measures were gestational age (GA) at delivery, delivery ≥35 weeks, ≥32 weeks, and PPROM. Multivariable regression analysis was performed to control for significant variables.
  
  
  RESULTS
  Seventy-four patients with singleton pregnancies underwent an ultrasound-indicated cerclage in the study period (47 Shirodkar, 27 McDonald). Shirodkar was associated with later GA at delivery (mean GA at delivery 36.98 +/- 3.39 vs. 33.34 +/- 6.37 weeks, p = 0.006), a higher likelihood of delivering ≥35 weeks (83 vs. 55.6%, p = 0.011) and ≥32 weeks (91.5 vs. 59.3%, p = 0.001), and a lower likelihood of preterm premature rupture of membrane (PPROM) (13.0 vs. 46.2%, p = 0.002). On adjusted analysis controlling for differing baseline characteristics, Shirodkar remained significantly associated with an increased incidence of delivery ≥32 weeks (odds ratio [OR]: 5.180, 95% CI: 1.024-26.205).
  
  
  CONCLUSIONS
  Compared to the McDonald technique, the Shirodkar technique was more effective in prolonging pregnancy in patients with singleton pregnancies undergoing ultrasound-indicated cerclage. A prospective trial is needed to compare these two techniques.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York University School of Medicine, New York, NY, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Hume
authors.forename: Andrei
authors.initials: A
authors.lastname: Rebarber
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Saltzman
authors.forename: Ashley S
authors.initials: AS
authors.lastname: Roman
authors.forename: Nathan S
authors.initials: NS
authors.lastname: Fox
mesh_terms: D000328:Adult; D017668:Age of Onset; D023802:Cerclage, Cervical / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000517:prevention & control; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000453:epidemiology / Q000601:surgery*