Transactions of the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal MedicineCerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: A randomized trial
Section snippets
Material and methods
Asymptomatic pregnant women who were identified at Thomas Jefferson University Hospital from February 1998 until June 2003 and at the University of Pennsylvania Hospital from February 2002 until June 2003 to have high risk factors for PTB were screened by TVU of the cervix every 2 weeks between 14 weeks 0 days of gestation and 23 weeks 6 days of gestation. High-risk factors for PTB were ≥1 PTB between 14 and 34 weeks of gestation, ≥2 curettage procedures for spontaneous/voluntary abortions,
Results
A flow diagram of participants is given in Figure. None of these women were included in previous publications. Of the 61 women who were assigned randomly to groups, 47 women (77%) had singleton gestations that were at high risk for PTB; 10 women (16%) had low-risk singleton gestations that were identified incidentally on anatomy ultrasound examination, and 4 women (7%) had twin gestations. Fifty-six women (92%) had a cervical length of <25 mm; five women (8%) were included with funneling >25%
Comment
TVU of the cervix has been studied extensively as a screening test for PTB. Several conditions must be met for a screening test to be considered beneficial and clinically useful. The condition of PTB is certainly important. There is a recognizable early phase, because the cervix first opens at the internal os while the patient is asymptomatic and before other changes are detectable. It has been shown to be safe and acceptable to women. It provides reliable (ie, reproducible) measurements, with
Acknowledgments
We thank all of the Maternal-Fetal Medicine research nurses (Michelle DeVito, Mary Talucci, Deb Dolan, Dori Henning), fellows, and attending physicians for help with recruitment; George Macones for independent interim analysis; and David Grimes for thoughtful review of the manuscript.
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Supported by awards from the Berlex Foundation, the Center for Research on Women and Newborn Health (CROWN) Foundation, and the Philadelphia Perinatal Society.
Presented at the Twenty-Fourth Annual Meeting of the Society for Maternal-Fetal Medicine, February 2-7, 2004, New Orleans, La.
Reprints will not be available from the authors.