title: [Prevention of preterm birth by Shirodkar cerclage--clinical results of a retrospective analysis].
abstract: In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early--tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment. As expected, gestational age at delivery was significantly lower after emergency cerclage (31 weeks) compared to prophylactic (36 weeks) and therapeutic cerclage (35 weeks). Prolongation differs significantly between the prophylactic (18 weeks), therapeutic (14 weeks) and emergency cerclage (10 weeks) groups. Conservative management achieved 8 weeks prolongation. Of note, particularly emergency cerclage in cases with advanced cervical incompetence resulted in a substantially higher pregnancy prolongation (10 weeks) compared to no intervention (one week). The efficiency of cerclage operations has to be assessed in a differentiated manner based on the clinical situation and indication. The clinical benefit depends strongly on proper patient selection.
authors.affiliation: Klinik Gynäkologie und Geburtshilfe, Universitätsklinik, Oldenburg.
authors.forename: R A
authors.initials: RA
authors.lastname: Schubert
authors.affiliation: Abteilung für Geburtshilfe, Universitätsklinikum, Friedrich-Schiller-Universität Jena.
authors.forename: E
authors.initials: E
authors.lastname: Schleussner
authors.affiliation: Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig.
authors.forename: J
authors.initials: J
authors.lastname: Hoffmann
authors.affiliation: Abteilung für Geburtshilfe, Universitätsklinikum, Friedrich-Schiller-Universität Jena.
authors.forename: A
authors.initials: A
authors.lastname: Fiedler
authors.affiliation: Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig.
authors.forename: H
authors.initials: H
authors.lastname: Stepan
authors.affiliation: Abteilung für Geburtsmedizin, Universitätsklinikum Leipzig.
authors.forename: A
authors.initials: A
authors.lastname: Gottschlich
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005858:Germany; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000517:prevention & control* / Q000601:surgery*