title: Time interval from elective removal of cervical cerclage to onset of spontaneous labour.
abstract: OBJECTIVE
  To determine the time interval between elective removal of a cervical cerclage to the onset of spontaneous labour in women who had either a history- or ultrasound-indicated cervical cerclage.
  
  
  METHODS
  A retrospective cohort study of women with a singleton pregnancy that had either a modified Shirodkar or McDonald cervical cerclage inserted were evaluated for the time interval between elective cerclage removal and onset of spontaneous labour and also spontaneous labour with 72 h of cervical cerclage removal.
  
  
  RESULTS
  Two hundred and sixty-nine singleton pregnancies with either a modified Shirodkar or McDonald cervical cerclage were analysed. The mean gestational age at cerclage removal was 36.7 ± 1.10 weeks and gestational age at spontaneous labour was 39.0 ± 1.94 weeks (mean ± SD). The median interval between cerclage removal and spontaneous labour was 14 days. Only 18% of women laboured spontaneously within 72 h. Women with ultrasound-indicated cerclage were more likely to deliver within 72 h, compared with women with a history-indicated cervical cerclage (odds ratio, 3.68; 95% confidence interval, 1.31-10.85, p=0.01).
  
  
  CONCLUSIONS
  Independent of the indication or technique used for cervical cerclage, the rate of early spontaneous labour following elective removal of cervical cerclage is sufficiently low to justify outpatient management.
authors.affiliation: Department of Obstetrics and Gynaecology, Imperial College NHS Trust, London, UK. lilianisama@yahoo.com
authors.forename: Lilian
authors.initials: L
authors.lastname: Alabi-Isama
authors.forename: Lynne
authors.initials: L
authors.lastname: Sykes
authors.forename: Manju
authors.initials: M
authors.lastname: Chandiramani
authors.forename: Sagar
authors.initials: S
authors.lastname: Patel
authors.forename: Raj
authors.initials: R
authors.lastname: Rai
authors.forename: Phillip R
authors.initials: PR
authors.lastname: Bennett
authors.forename: T G
authors.initials: TG
authors.lastname: Teoh
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007743:Labor, Obstetric / Q000502:physiology*; D011247:Pregnancy; D012189:Retrospective Studies; D013995:Time; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000601:surgery*