title: Cervical lacerations in planned versus labor cerclage removal: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to evaluate the incidence of cervical lacerations with cerclage removal planned before labor compared to after the onset of labor by a systematic review of published studies.
  
  
  METHODS
  Searches were performed in electronic databases from inception of each database to November 2014. We identified all studies reporting the rate of cervical lacerations and the timing of cerclage removal (either before or after the onset of labor). The primary outcome was the incidence of spontaneous and clinically significant intrapartum cervical lacerations (i.e. lacerations requiring suturing).
  
  
  RESULTS
  Six studies, which met the inclusion criteria, were included in the analysis. The overall incidence of cervical lacerations was 8.9% (32/359). There were 23/280 (6.4%) cervical lacerations in the planned removal group, and 9/79 (11.4%) in the removal after labor group (odds ratio 0.70, 95% confidence interval 0.31-1.57).
  
  
  CONCLUSIONS
  In summary, planned removal of cerclage before labor was not shown to be associated with statistically significant reduction in the incidence of cervical lacerations. However, since that our data probably did not reach statistical significance because of a type II error, further studies are needed.
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Simonazzi
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Curti
authors.affiliation: Department of Medical Surgical Sciences, Division of Obstetrics and Prenatal Medicine, St. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Bisulli
authors.affiliation: Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, MD, USA.
authors.forename: Viola
authors.initials: V
authors.lastname: Seravalli
authors.affiliation: Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Saccone
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA. Electronic address: Vincenzo.berghella@jefferson.edu.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Berghella
mesh_terms: D023802:Cerclage, Cervical / Q000009:adverse effects*; D002584:Cervix Uteri / Q000293:injuries*; D020878:Device Removal; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007745:Labor Onset; D022125:Lacerations / Q000453:epidemiology* / Q000209:etiology*; D011247:Pregnancy
keywords: Cervical lacerations; Labor; Preterm birth; Preterm labor