title: Randomized trial of ultrasound-indicated cerclage in singleton women without lower genital tract inflammation.
abstract: OBJECTIVE
  This is the first report of a randomized trial of cerclage on pure cervical shortening without vaginosis or cervicitis. The objective of our multicenter randomized controlled trial was to assess the benefits of ultrasound-indicated cervical cerclage in the mid-trimester to prevent preterm birth in women who have no signs of infection or inflammation of the lower genital tract.
  
  
  METHODS
  Women with a short cervical length < 25 mm between 16 and 26 weeks of gestation were randomly assigned to receive a Shirodkar cerclage, McDonald cerclage, or bedrest (no cerclage). Before being randomly assigned to one of the three groups, all women were screened for infection/inflammation of the lower genital tract; those with positive results were excluded from the study. The ratio of preterm delivery as a primary end-point was evaluated in the groups.
  
  
  RESULTS
  A total of 106 singleton patients with a short cervical length were assessed for study eligibility; 106 patients were randomized to the three treatment options. Ultimately, 98 patients (in the Shirodkar [n = 34], McDonald [n = 34] and bedrest [n = 30] groups) were analyzed. No differences in preterm delivery or perinatal outcomes were found between the three groups. Significantly fewer patients in the Shirodkar group required hospitalization for treatment of threatened preterm labor when compared to patients in the bedrest group.
  
  
  CONCLUSIONS
  For women with a short cervical length < 25 mm between 16 and 26 weeks of gestation, Shirodkar cerclage might be considered to reduce the occurrence of threatened preterm labor.
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Showa University Koto Toyosu Hospital, Tokyo, Japan.
authors.forename: Katsufumi
authors.initials: K
authors.lastname: Otsuki
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Nakai
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, International University of Health and Welfare, Tochigi, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Matsuda
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Fetal Medicine Research Unit, Kanagawa, Japan.
authors.forename: Norio
authors.initials: N
authors.lastname: Shinozuka
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Nippon Medical School, Musashi-Kosugi Hospital, Tokyo, Japan.
authors.forename: Ikuno
authors.initials: I
authors.lastname: Kawabata
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Makino
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Tokyo University, Tokyo, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Kyorin University, Tokyo, Japan.
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Iwashita
authors.affiliation: Japanese Organization of Prevention of Preterm Delivery, Tokyo, Japan.|Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Okai
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D054791:Cervical Length Measurement; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000517:prevention & control*; D014463:Ultrasonography; D002575:Uterine Cervicitis / Q000150:complications* / Q000175:diagnosis; D016585:Vaginosis, Bacterial / Q000150:complications* / Q000175:diagnosis
keywords: cervical shortening; randomized trial; transvaginal ultrasound cervical cerclage