title: Comparison of 2 stitches vs 1 stitch for transvaginal cervical cerclage for preterm birth prevention.
abstract: OBJECTIVE
  The objective of the study was to compare the efficacy and outcomes of 2 vs 1 stitch at the time of cervical cerclage placement for preterm birth prevention.
  
  
  METHODS
  This was a retrospective cohort study of women with singleton gestation undergoing history- or ultrasound-indicated transvaginal cervical cerclage prior to 24 weeks. The primary outcome was delivery at less than 37 weeks. The secondary outcomes included gestational age at delivery at less than 35, less than 34, less than 32, less than 28, and less than 24 weeks, perioperative details at the time of cerclage placement and removal, and maternal and neonatal outcomes. Comparison was made between patients with 2 vs 1 stitch at the time of cerclage placement. History- and ultrasound-indicated cerclages were analyzed separately.
  
  
  RESULTS
  Four hundred forty-four patients met inclusion criteria, 237 being history indicated (2 stitches, n = 86, 1 stitch, n = 151), and 207 ultrasound indicated (2 stitches, n = 117, 1 stitch, n = 90). Gestational age at delivery at less than 37 weeks was not significantly different between the 2 groups for both history- and ultrasound-indicated cerclage, even after adjusting for demographic differences and suture type (39% vs 35%; adjusted odds ratio, 1.38; 95% confidence interval, 0.64-3.01; and 44% vs 49%; adjusted odds ratio, 0.66; 95% confidence interval, 0.27-1.61, respectively).
  
  
  CONCLUSIONS
  Two stitches at the time of cerclage do not appear to improve pregnancy outcome either in the history- or the ultrasound-indicated procedures, compared with 1 stitch.
authors.affiliation: Division of Maternal-Fetal Medicine, Albert Einstein Medical Center, Thomas Jefferson University, Philadelphia, PA, USA.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Giraldo-Isaza
authors.forename: Grace P
authors.initials: GP
authors.lastname: Fried
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Hegarty
authors.forename: Maria A
authors.initials: MA
authors.lastname: Suescum-Diaz
authors.forename: Arnold W
authors.initials: AW
authors.lastname: Cohen
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control* / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D013536:Suture Techniques; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000601:surgery*