Shirodkar versus McDonald Cerclage for the Prevention of Preterm Birth in Women with Short Cervical Length

Anthony O. Odibo; Vincenzo Berghella; Meekai S. To; Orion A. Rust; Sietske M. Althuisius; Kypros H. Nicolaides

doi:10.1055/s-2006-958165

American Journal of Perinatology, Table of Contents

Am J Perinatol 2007; 24(1): 055-060
DOI: 10.1055/s-2006-958165

Shirodkar versus McDonald Cerclage for the Prevention of Preterm Birth in Women with Short Cervical Length

Anthony O. Odibo¹ ^, ² , Vincenzo Berghella³ , Meekai S. To⁴ , Orion A. Rust⁵ , Sietske M. Althuisius⁶ , Kypros H. Nicolaides⁷

¹Department of Obstetrics and Gynecology, Washington University Medical Center, St. Louis, Missouri
²Center for Clinical Epidemiology and Biostatistic, University of Pennsylvania, Philadelphia, Pennsylvania
³Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania
⁴St. Thomas and Guy's Hospital, London, United Kingdom
⁵Lehigh Valley Hospital Health Network, Allentown, Pennsylvania
⁶Leeds General Infirmary, Leeds, United Kingdom
⁷Harris Birthright Research Centre for Fetal Medicine, King's College, London University, London, United Kingdom

Abstract

ABSTRACT

The efficacy of Shirodkar cerclage was compared with that of the McDonald procedure for the prevention of preterm birth (PTB) in women with a short cervix. Secondary analysis using data from all published randomized trials including women with a short cervical length (CL) was performed comparing the use of Shirodkar versus McDonald sutures. Analysis was limited to singletons with short CL on transvaginal ultrasound. The primary outcome measure was PTB < 33 weeks. Statistical analysis was performed using bivariate and multivariable techniques. From 607 women randomly assigned in the study, 277 met our inclusion criteria; 127 received Shirodkar and 150 women received McDonald sutures. The mean ( ± standard deviation) gestational age at delivery was 35.0 ± 5.3 versus 36.3 ± 4.7 for the Shirodkar versus McDonald groups, respectively (p < 0.02). PTB < 33 weeks was seen in 61 (22%) of 277 women; 26 (20%) of 127 in the Shirodkar and 35 (23%) of 150 in the McDonald groups, respectively (odds ratio [OR], 0.85; 95% confidence interval [CI], 0.5 to 1.6). On adjusting for confounders using logistic regression modeling, no significant difference in PTB < 33 weeks was found between the two groups (OR, 0.55; 95% CI, 0.2 to 1.3). In women with short cervical length randomly assigned to receiving cerclage, no significant difference in prevention of PTB was observed using Shirodkar or McDonald's procedures.

KEYWORDS

Short cervix - cerclage - McDonald - Shirodkar - preterm prevention

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References

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Anthony OdiboM.D.

Division of Maternal Fetal Medicine and Ultrasound, Washington University School of Medicine

660 South Euclid, Campus Box 8064, St. Louis, MO 63110