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Créée le : 30 Jan 2004
Modifiée le : 26 Nov 2018

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Notice bibliographique (sans auteurs) :

Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial. The Lancet 2004;363(9424):1849-53.

Auteur·e(s) :

Meekai S To, Prof Zarko Alfirevic, Victoria CF Heath, Simona Cicero, Ana Maria Cacho, Paula R Williamson, Prof Kypros H Nicolaides, MRCOG

Année de publication :

2004

URL(s) :

https://www.thelancet.com/journals/lancet/article/…
https://doi.org/10.1016/S0140-6736(04)16351-4

Résumé (français)  :

Abstract (English)  :

Background
Cervical cerclage has been widely used in the past 50 years to prevent early preterm birth and its associated neonatal mortality and morbidity. Results of randomised trials have not generally lent support to this practice, but this absence of benefit may be due to suboptimum patient selection, which was essentially based on obstetric history. A more effective way of identifying the high-risk group for early preterm delivery might be by transvaginal sonographic measurement of cervical length. We undertook a multicentre randomised controlled trial to investigate whether, in women with a short cervix identified by routine transvaginal scanning at 22-24 weeks’ gestation, the insertion of a Shirodkar suture reduces early preterm delivery.

Methods
Cervical length was measured in 47 123 women. The cervix was 15 mm or less in 470, and 253 (54%) of these women participated in the study and were randomised to cervical cerclage (127) or to expectant management (126). Primary outcome was the frequency of delivery before 33 completed weeks (231 days) of pregnancy.

Findings
The proportion of preterm delivery before 33 weeks was similar in both groups, 22% (28 of 127) in the cerclage group versus 26% (33 of 126) in the control group (relative risk=0·84, 95% CI 0·54-1·31, p=0·44), with no significant differences in perinatal or maternal morbidity or mortality.

Interpretation
The insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery. Routine sonographic measurement of cervical length at 22-24 weeks identifies a group at high risk of early preterm birth.

Sumário (português)  :

Resumen (español)  :

Remarques :

Argument (français) :

Le cerclage des cols courts n’empeche pas les accouchements prématurés.

Argument (English):

The insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery.

Argumento (português):

A inserção de uma sutura de Shirodkar em mulheres com colo do útero curto não reduz substancialmente o risco de parto prematuro precoce.

Argumento (español):

Mots-clés :

➡ cerclage ; prématuré prématurés ; protocoles ; morbidité ; consentement éclairé

Auteur·e de cette fiche :

Cécile Loup — 30 Jan 2004
➡ dernière modification : Bernard Bel — 26 Nov 2018