RENO, NEV. — There was no reduction in preterm birth but a higher cerclage rate and a doubling of hospital days when cervical scanning, rather than obstetric history, was used to determine necessity for the procedure.
Results of the randomized, controlled CIRCLE (Assessment of Cervical Cerclage for the Prevention of Preterm Labour) trial do not suggest any benefit in replacing historical indications for suture placement with ultrasound surveillance, Dr. Rachael Simcox said at the annual meeting of the Society for Gynecologic Investigation.
Dr. Simcox and associates recruited 247 women from nine centers in the United Kingdom carrying singleton pregnancies of less than 24 weeks' gestation and at high risk of preterm birth because of a history of a previous spontaneous delivery between 16 and 34 weeks.
They were stratified based on gestational age at previous preterm birth, then randomized to one of two groups. In the scanning arm, women were followed with trans- vaginal ultrasound every 2 weeks. If cervical length was 20 mm or less, the woman received a cerclage. In the traditional arm, cerclage placement was based on obstetric history and physician discretion. The groups were well matched for ethnicity, smoking status, and obstetric and surgical history.
Women in the scan group were 1.6 times more likely to receive a cerclage (39 of 122), compared with those in the history group (25 of 125). They also spent a total of 495 days in the hospital, compared with 240 days for the traditionally managed women, said Dr. Simcox of the division of reproductive health, endocrinology, and development at King's College London. The scan patients were significantly more likely to receive progesterone than those in the traditional arm (48 vs. 32, respectively), yet despite more intervention, they were not statistically more likely to deliver at term.
Late miscarriages were numerically more common in the traditionally managed group, but the numbers did not reach significance (12 of 125 vs. 4 of 122). Tommy's, the Baby Charity provided funding.
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