NEW YORK (Reuters Health) – Among women with a singleton pregnancy, prior preterm birth, and a short cervix, cerclage significantly reduces the risk of another preterm delivery, as well as perinatal mortality and morbidity, according to the results of a new meta-analysis.

The findings are reported in the March issue of Obstetrics & Gynecology by Dr. Vincenzo Berghella, with Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania and colleagues.

They note that early randomized trials that evaluated the effectiveness of ultrasound-indicated cerclage for short cervical length showed contradictory results, but more recently benefit was seen in women with singleton pregnancies and previous spontaneous preterm birth.

To look at “the totality of the data,” the team identified five randomized trials of cerclage in women with short cervical length on second-trimester transvaginal ultrasonography.

Among women with previous spontaneous preterm birth and singleton gestation, with cervical length less than 25 mm before 24 weeks gestation, the preterm birth rate before 35 weeks was 28.4 % in the cerclage group compared with 41.3% in the no-cerclage group (relative risk 0.70).

In addition, the relative risk of the composite outcome of perinatal mortality and morbidity was 15.6% versus 24.8% with and without cerclage, respectively (RR 0.64).

“The benefit of cerclage in this selected population is clear,” conclude Dr. Berghella and colleagues. “These results, consistent in five different trials, offer level 1 evidence for benefit from cerclage in a selected population of women at high risk.”

Reference:

Cerclage for Short Cervix on Ultrasonography in Women With Singleton Gestations and Previous Preterm Birth: A Meta-Analysis

Obstet Gynecol 2011;117:663–671.