title: Double versus single cervical cerclage for the prevention of preterm births.
abstract: OBJECTIVE
  To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes.
  
  
  METHODS
  We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines.
  
  
  RESULTS
  Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34 weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28 weeks (645 cases, OR 0.43, 95% CI 0.26-0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37 weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82).
  
  
  CONCLUSIONS
  It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Medical School, Athens University , Athens , Greece and.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Pergialiotis
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Vlachos
authors.forename: Anastasia
authors.initials: A
authors.lastname: Prodromidou
authors.forename: Despina
authors.initials: D
authors.lastname: Perrea
authors.forename: Eleana
authors.initials: E
authors.lastname: Gkioka
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Vlachos
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000517:prevention & control*
keywords: Gestational age; PPROM; pregnancy loss; premature