The effect of cervical cerclage on the labor curve.

Female Pregnancy Infant, Newborn Humans Cerclage, Cervical Premature Birth / diagnosis Retrospective Studies Labor, Obstetric Cervix Uteri
active labor latent phase protracted labor and arrest vaginal delivery

Journal

American journal of obstetrics & gynecology MFM
ISSN: 2589-9333
Titre abrégé: Am J Obstet Gynecol MFM
Pays: United States
ID NLM: 101746609

Informations de publication

Date de publication:
04 2023
Historique:
received: 18 12 2022
accepted: 26 12 2022
medline: 3 4 2023
pubmed: 3 1 2023
entrez: 2 1 2023
Statut: ppublish

Résumé

Cervical cerclage is an effective intervention to prevent preterm birth among individuals with a history of cervical insufficiency, individuals with a short cervix and history of preterm birth, or individuals with second-trimester painless dilation. Although cerclage reduces the mechanical stress on the cervix by reinforcing it with sutures, cerclage could also cause scarring of the cervix, which may affect the progress of labor. This study aimed to compare the labor curves between individuals who underwent cerclage and those who did not undergo cerclage. This was a retrospective cohort study of individuals with singleton term pregnancy, vertex presentation, and vaginal delivery, using the data from the Consortium on Safe Labor. We excluded individuals with fetal anomalies, stillbirth, or abnormal perinatal outcomes, including 5-minute Apgar score of <7, birth injury, and neonatal intensive care unit admission. We modeled the course of cervical dilation using repeated-measures analysis with a polynomial function and generated smoothed labor curves. An interval-censored regression analysis was performed to estimate traverse times (the elapsed time between 2 cervical dilation measures). The traverse times were compared between individuals who underwent cerclage and those who did not undergo cerclage, controlling for induction of labor and parity. There were 245 individuals who underwent cerclage and 110,080 individuals who did not undergo cerclage. Individuals who underwent cerclage compared with those who did not undergo cerclage had a similar traverse time from 1 to 6 cm (median, 9.1 vs 10.3 hours; adjusted P=.37) and from 6 to 10 cm (median, 1.5 vs 1.5 hours; adjusted P=.23). Individuals who underwent cerclage compared with those who did not undergo cerclage had a longer traverse time from rupture of membranes to delivery (median, 4.0 vs 3.0 hours; adjusted P<.01). Cervical cerclage did not affect the overall progress of labor.

Sections du résumé

BACKGROUND
Cervical cerclage is an effective intervention to prevent preterm birth among individuals with a history of cervical insufficiency, individuals with a short cervix and history of preterm birth, or individuals with second-trimester painless dilation. Although cerclage reduces the mechanical stress on the cervix by reinforcing it with sutures, cerclage could also cause scarring of the cervix, which may affect the progress of labor.
OBJECTIVE
This study aimed to compare the labor curves between individuals who underwent cerclage and those who did not undergo cerclage.
STUDY DESIGN
This was a retrospective cohort study of individuals with singleton term pregnancy, vertex presentation, and vaginal delivery, using the data from the Consortium on Safe Labor. We excluded individuals with fetal anomalies, stillbirth, or abnormal perinatal outcomes, including 5-minute Apgar score of <7, birth injury, and neonatal intensive care unit admission. We modeled the course of cervical dilation using repeated-measures analysis with a polynomial function and generated smoothed labor curves. An interval-censored regression analysis was performed to estimate traverse times (the elapsed time between 2 cervical dilation measures). The traverse times were compared between individuals who underwent cerclage and those who did not undergo cerclage, controlling for induction of labor and parity.
RESULTS
There were 245 individuals who underwent cerclage and 110,080 individuals who did not undergo cerclage. Individuals who underwent cerclage compared with those who did not undergo cerclage had a similar traverse time from 1 to 6 cm (median, 9.1 vs 10.3 hours; adjusted P=.37) and from 6 to 10 cm (median, 1.5 vs 1.5 hours; adjusted P=.23). Individuals who underwent cerclage compared with those who did not undergo cerclage had a longer traverse time from rupture of membranes to delivery (median, 4.0 vs 3.0 hours; adjusted P<.01).
CONCLUSION
Cervical cerclage did not affect the overall progress of labor.

Identifiants

DOI: 10.1016/j.ajogmf.2022.100858 PMID: 36592821
pubmed: 36592821
pii: S2589-9333(22)00288-9
doi: 10.1016/j.ajogmf.2022.100858
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

100858

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Auteurs

Kazuma Onishi (K)

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Onishi and Kawakita).

Jim C Huang (JC)

Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (Dr Huang).

Tetsuya Kawakita (T)

Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA (Drs Onishi and Kawakita). Electronic address: tetsuya.x.kawakita@gmail.com.

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Classifications MeSH

questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Personnes › Tranches d'âge › Nourrisson › Nouveau-né › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie obstétrique › Cerclage cervical › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Travail obstétrical prématuré › Naissance prématurée › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Phénomènes physiologiques des appareils urinaire et reproducteur › Phénomènes physiologiques de la reproduction › Reproduction › Grossesse › Travail obstétrical › The effect of cervical cerclage on the labor curve.
questionsmedicales.fr › Appareil urogénital › Système génital › Système génital de la femme › Utérus › Col de l'utérus › The effect of cervical cerclage on the labor curve.