Vol 92, No 10 (2021)
Research paper
Published online: 2021-04-20

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Can prophylactic transvaginal cervical cerclage improve pregnancy outcome in patients receiving cervical conization? A meta-analysis

Ting Wang1, Ruoan Jiang1, Yingsha Yao1, Xiufeng Huang1
Pubmed: 33914333
Ginekol Pol 2021;92(10):704-713.

Abstract

Objectives: Cervical conization could increase the risk of cervical insufficiency. This study systematically evaluated the value of prophylactic transvaginal cervical cerclage following cervical conization with regards to pregnancy outcome.
Material and methods: We performed a systematic review of the literature, using Web of Science, and Embase, the published time ranged from the date that database established to December 2019. Pregnant patients, who had a previous history of cervical conization for CIN or early cervical cancer, were enrolled. Two researchers searched these databases and estimated the included studies’ quality independently, depending on the same criteria.
Results: Our meta-analysis is incorporate 3560 cases eventually. Meta-analysis showed that when compared to the no-cerclage group, the risk ratio (RR) of preterm birth in the prophylactic transvaginal cervical cerclage group was 1.85 [95% confidence interval (CI): 1.22–2.80; p = 0.004]; the RR of premature rupture of membranes was 1.5 (95% CI: 1.17–1.93; p = 0.001).
Conclusions: The rates of preterm birth were significantly higher in women following cervical conization with transvaginal cerclage than those without cerclage.

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References

  1. Prendiville W. The treatment of CIN: what are the risks? Cytopathology. 2009; 20(3): 145–153.
  2. Rincon M, Pereira LMR. Ambulatory management of preterm labor. Clin Obstet Gynecol. 2012; 55(3): 756–764.
  3. Albrechtsen S, Rasmussen S, Thoresen S, et al. Pregnancy outcome in women before and after cervical conisation: population based cohort study. BMJ. 2008; 337: a1343.
  4. Bjørge T, Skare GB, Bjørge L, et al. Adverse pregnancy outcomes after treatment for cervical intraepithelial neoplasia. Obstet Gynecol. 2016; 128(6): 1265–1273.
  5. Berghella V, Pereira L, Gariepy A, et al. Prior cone biopsy: prediction of preterm birth by cervical ultrasound. Am J Obstet Gynecol. 2004; 191(4): 1393–1397.
  6. Crane JMG, Delaney T, Hutchens D. Transvaginal ultrasonography in the prediction of preterm birth after treatment for cervical intraepithelial neoplasia. Obstet Gynecol. 2006; 107(1): 37–44.
  7. Armarnik S, Sheiner E, Piura B, et al. Obstetric outcome following cervical conization. Arch Gynecol Obstet. 2011; 283(4): 765–769.
  8. Cho GJ, Ouh YT, Kim LY, et al. Cerclage is associated with the increased risk of preterm birth in women who had cervical conization. BMC Pregnancy Childbirth. 2018; 18(1): 277.
  9. Kindinger LM, Kyrgiou M, MacIntyre DA, et al. Preterm Birth Prevention Post-Conization: A Model of Cervical Length Screening with Targeted Cerclage. PLoS One. 2016; 11(11): e0163793.
  10. Miyakoshi K, Itakura A, Abe T, et al. Risk of preterm birth after the excisional surgery for cervical lesions: a propensity-score matching study in Japan. J Matern Fetal Neonatal Med. 2021; 34(6): 845–851.
  11. Nam KaH, Kwon JaY, Kim YH, et al. Pregnancy outcome after cervical conization: risk factors for preterm delivery and the efficacy of prophylactic cerclage. J Gynecol Oncol. 2010; 21(4): 225–229.
  12. Rafaeli-Yehudai T, Kessous R, Aricha-Tamir B, et al. The effect of cervical cerclage on pregnancy outcomes in women following conization. J Matern Fetal Neonatal Med. 2014; 27(15): 1594–1597.
  13. Shin MY, Seo ES, Choi SJ, et al. The role of prophylactic cerclage in preventing preterm delivery after electrosurgical conization. J Gynecol Oncol. 2010; 21(4): 230–236.
  14. Wei M, Jin X, Li TC, et al. A comparison of pregnancy outcome of modified transvaginal cervicoisthmic cerclage performed prior to and during pregnancy. Arch Gynecol Obstet. 2018; 297(3): 645–652.
  15. Zeisler H, Joura EA, Bancher-Todesca D, et al. Prophylactic cerclage in pregnancy. Effect in women with a history of conization. J Reprod Med. 1997; 42(7): 390–392.
  16. Paraskevaidis E, Koliopoulos G, Lolis E, et al. Delivery outcomes following loop electrosurgical excision procedure for microinvasive (FIGO stage IA1) cervical cancer. Gynecol Oncol. 2002; 86(1): 10–13.
  17. Santesso N, Mustafa RA, Schünemann HJ, et al. Guideline Support Group. World Health Organization Guidelines for treatment of cervical intraepithelial neoplasia 2-3 and screen-and-treat strategies to prevent cervical cancer. Int J Gynaecol Obstet. 2016; 132(3): 252–258.
  18. Castle PE, Murokora D, Perez C, et al. Treatment of cervical intraepithelial lesions. Int J Gynaecol Obstet. 2017; 138 Suppl 1: 20–25.
  19. Kirn V, Geiger P, Riedel C, et al. Cervical conisation and the risk of preterm delivery: a retrospective matched pair analysis of a German cohort. Arch Gynecol Obstet. 2015; 291(3): 599–603.
  20. Gatta LA, Kuller JA, Rhee EHJ. Pregnancy outcomes following cervical conization or loop electrosurgical excision procedures. Obstet Gynecol Surv. 2017; 72(8): 494–499.
  21. Cunningham F, Gant N, Leveno K, et al. Williams Obstetrics, 21st Edition. Journal of Midwifery & Women's Health. 2010; 48(5): 369–369.
  22. Brown R, Gagnon R, Delisle MF. No. 373-cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019; 41(2): 233–247.
  23. Chen Q, Chen G, Li N. Clinical effect of emergency cervical cerclage and elective cervical cerclage on pregnancy outcome in the cervical-incompetent pregnant women. Arch Gynecol Obstet. 2018; 297(2): 401–407.
  24. Liu Y, Ke Z, Liao W, et al. Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women. Arch Gynecol Obstet. 2018; 297(6): 1503–1508.
  25. Ades A, Hawkins DP. Laparoscopic transabdominal cerclage and subsequent pregnancy outcomes when left in situ. Obstet Gynecol. 2019; 133(6): 1195–1198.
  26. Alfirevic Z, Stampalija T, Medley N, et al. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2012; 6(4): CD008991.
  27. Kassanos D, Salamalekis E, Vitoratos N, et al. The value of transvaginal ultrasonography in diagnosis and management of cervical incompetence. Clin Exp Obstet Gynecol. 2001; 28(4): 266–268.
  28. Mitra A, Kindinger L, Kalliala I, et al. Obstetric complications after treatment of cervical intraepithelial neoplasia. Br J Hosp Med (Lond). 2016; 77(8): C124–C127.
  29. Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomised trial of cervical cerclage. MRC/RCOG Working Party on Cervical Cerclage. Br J Obstet Gynaecol. 1993; 100(6): 516–523.
  30. Althuisius SM, Dekker GA, Hummel P, et al. Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2001; 185(5): 1106–1112.
  31. Sentilhes L, Sénat MV, Ancel PY, et al. Prevention of spontaneous preterm birth: Guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF). Eur J Obstet Gynecol Reprod Biol. 2017; 210: 217–224.
  32. Kaye D, Kaye D. Risk factors for preterm premature rupture of membranes at Mulago Hospital, Kampala. East Afr Med J. 2001; 78(2): 65–69.
  33. Giraldo-Isaza MA, Berghella V. Cervical cerclage and preterm PROM. Clin Obstet Gynecol. 2011; 54(2): 313–320.
  34. Joung EJ, Go EB, Kwack JY, et al. Successful term delivery cases of trans-abdominal cervicoisthmic cerclage performed at more than 18 weeks of gestation. Obstet Gynecol Sci. 2016; 59(4): 319–322.
  35. Shennan A. A multicentre randomised controlled trial of transabdominal versus transvaginal cervical cerclage. http://isrctn.org/>. .
  36. Martin-Hirsch PL, Paraskevaidis E, Kitchener H. Surgery for cervical intraepithelial neoplasia. Cochrane Database Syst Rev. 2000(2): CD001318.
  37. Kigure K, Nakamura K, Kitahara Y, et al. An electrical scalpel conization versus Shimodaira-Taniguchi conization procedure for cervical intraepithelial neoplasia. Medicine (Baltimore). 2018; 97(41): e12640.
  38. Guo HJ, Guo RX, Liu YL. Effects of loop electrosurgical excision procedure or cold knife conization on pregnancy outcomes. Eur J Gynaecol Oncol. 2013; 34(1): 79–82.
  39. Schwarz TM, Kolben T, Gallwas J, et al. Comparison of two surgical methods for the treatment of CIN: classical LLETZ (large-loop excision of the transformation zone) versus isolated resection of the colposcopic apparent lesion - study protocol for a randomized controlled trial. Trials. 2015; 16: 225.
  40. Kyrgiou M, Athanasiou A, Kalliala IEJ, et al. Obstetric outcomes after conservative treatment for cervical intraepithelial lesions and early invasive disease. Cochrane Database Syst Rev. 2017; 11: CD012847.