title: The impact of obesity on cervical cerclage efficacy: A systematic review of the literature.
abstract: BACKGROUND
  Cervical cerclage is a commonly applied procedure which is used as a preventive measure against preterm births among women with a short cervix (<25mm) or with previous painless mid-trimester pregnancy losses. The purpose of the present study is to evaluate whether the presence of maternal obesity reduces the efficacy of cervical cerclage.
  
  
  METHODS
  We searched Medline (1966-2015), Scopus (2004-2015), Popline (1974-2015) and ClinicalTrials.gov (2008-2015) along with reference lists of electronically retrieved studies.
  
  
  RESULTS
  Three studies were included in our review which involved 606 women. Among them 210 were obese (BMI>30 kg/m2) and 47 morbidly obese (BMI >40 kg/m2). The presence of obesity among women who had a cervical cerclage due to ultrasound or history indications did not seem to affect the gestational age at delivery or the neonatal birthweight. Furthermore, according to the findings of a single study it did not seem to reduce the gestational latency period in days (normal weight group 24.3±3.2, overweight group 21.1±5.1, obese group 21.4±4.9 p = 0.171).
  
  
  CONCLUSIONS
  According to the findings of our systematic review obesity does not influence the efficacy of cervical cerclage. However, firm results are precluded due to the small number and the methodological heterogeneity of existing studies. Further, studies are needed to corroborate our findings.
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Prodromidou
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Frountzas
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Perrea
authors.affiliation: 1st Departmentt of Obstetrics and Gynecology, Athens University, Medical School, Greece.
authors.forename: G D
authors.initials: GD
authors.lastname: Vlachos
authors.affiliation: Laboratory of Experimental Surgery and Surgical Research N.S. Christeas, Athens University, Medical School, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Pergialiotis
mesh_terms: D023802:Cerclage, Cervical; D036861:Delivery, Obstetric; D005260:Female; D005865:Gestational Age; D006801:Humans; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control / Q000601:surgery*; D047928:Premature Birth / Q000517:prevention & control*; D012307:Risk Factors; D002581:Uterine Cervical Incompetence / Q000601:surgery*
keywords: BMI; cerclage; obesity; preterm; weight