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Cervical cerclage placed before 14 weeks gestation in women with one previous midtrimester loss: A population-based cohort study.
- Source :
- Australian & New Zealand Journal of Obstetrics & Gynaecology; Dec2017, Vol. 57 Issue 6, p593-598, 6p
- Publication Year :
- 2017
-
Abstract
- Background Cervical cerclage is used in an attempt to reduce recurrence risk of preterm birth, but evidence for use is limited. Aims To compare pregnancy outcomes among women with a single previous midtrimester delivery when managed with or without a cervical cerclage. Materials and methods Population-based cohort study of all women in New South Wales, Australia with a singleton pregnancy ending in birth/miscarriage ≥14 and <28 weeks, between 2003 and 2011. Modified Poisson regression was used to compare outcomes in the next subsequent pregnancy, for women with a cerclage inserted <14 weeks, and those without cerclage. The primary outcome was gestational age <37 weeks at birth/miscarriage in the next pregnancy. Secondary outcomes included: maternal morbidity, preterm prelabour rupture of membranes ( PPROM), stillbirth/neonatal death and composite neonatal morbidity for liveborn infants ≥28 weeks. Adjusted risk ratios ( ARR) and 95% confidence intervals ( CI) were determined. Results Five thousand, six hundred and ninety-eight births/miscarriages were potential index deliveries. Of these, 2175 women had an eligible subsequent pregnancy: 108 received cerclage at <14 weeks gestation, 2067 did not. Women with cerclage were significantly more likely to deliver <37 weeks than those without (39.8% vs 19.3%, ARR 1.92, 95% CI 1.48-2.48), and had increased risks of PPROM ( ARR 4.38, 95% CI 2.62-7.32) and stillbirth/neonatal death ( ARR 2.20, 95% CI 1.02-4.73). Following cerclage, liveborn infants ≥28 weeks had double the risk of severe morbidity ( ARR 2.54, 95% CI 1.55-4.16). Conclusions In women with a single previous midtrimester delivery, cervical cerclage <14 weeks gestation in subsequent pregnancy was associated with worse pregnancy outcomes. [ABSTRACT FROM AUTHOR]
- Subjects :
- EVALUATION of medical care
PREMATURE infants
CHI-squared test
CONFIDENCE intervals
GESTATIONAL age
LONGITUDINAL method
PERINATAL death
PREGNANCY
PREGNANCY complications
PROBABILITY theory
REGRESSION analysis
RESEARCH funding
DATA analysis software
DESCRIPTIVE statistics
KAPLAN-Meier estimator
CERVICAL cerclage
PREVENTION
Subjects
Details
- Language :
- English
- ISSN :
- 00048666
- Volume :
- 57
- Issue :
- 6
- Database :
- Complementary Index
- Journal :
- Australian & New Zealand Journal of Obstetrics & Gynaecology
- Publication Type :
- Academic Journal
- Accession number :
- 126565596
- Full Text :
- https://doi.org/10.1111/ajo.12635