title: Tocolytics used as adjunctive therapy at the time of cerclage placement: a systematic review.
abstract: OBJECTIVE
  To review the published literature on whether the use of empiric perioperative tocolytic medications could provide additional benefit when used in combination with cerclage.
  
  
  METHODS
  Systematic review of published medical literature reporting the efficacy of empiric tocolytics used as a perioperative adjunct to vaginal cerclage in high-risk patients. A PubMed search without date criteria of various tocolytics and cerclage yielded 42 studies. Review articles were excluded, as were reports of abdominal cerclage, emergent cerclage, or cerclage for the purpose of delayed interval delivery in twin gestations.
  
  
  RESULTS
  Only five publications on the topic of perioperative tocolytic use at the time of history or ultrasound-indicated vaginal cerclage placement were identified. These included zero clinical trials, three retrospective cohort studies, one case series and one case report. Only one cohort study compared cerclage with indomethacin and cerclage without indomethacin and suggested no difference between the groups. The other two published cohort studies had no referent group who received cerclage without tocolysis. One case series and one case report were also published reporting cerclage with empiric beta-mimetic and progesterone adjunctive therapy.
  
  
  CONCLUSIONS
  There is a paucity of published data on the topic of adjunctive perioperative tocolytics with cerclage. Adequately powered clinical trials on perioperative use of tocolysis with cerclage compared with a standard cerclage placement alone are needed to establish efficacy. Until adequately studied, this practice should be considered investigational.
authors.affiliation: 1] Wayne State University School of Medicine, Detroit, MI, USA [2] Children's Hospital of Michigan, Division of Genetic and Metabolic Disorders, Detroit, MI, USA.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: 1] Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA [2] Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: DeFranco
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D023802:Cerclage, Cervical / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000627:therapeutic use; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology*; D016032:Randomized Controlled Trials as Topic; D015149:Tocolytic Agents / Q000627:therapeutic use*; D002581:Uterine Cervical Incompetence / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015149:Tocolytic Agents; D007213:Indomethacin