According to a report, ultrasound which is used to determine the need for cervical cerclage may not improve outcomes over those obtained with history-indicated placement.
The team led by Dr. Andrew H. Shennan from St. Thomas’ Hospital, King’s College London, UK analyzed that the traditional approach are leading to unnecessary procedures of employing cerclage based on a history of premature delivery. They conducted a study to compare elective management (suture placement decision based on obstetric history alone) with cerclage performed only when ultrasonography showed cervical measurement of 20 mm or less.
Most of the large randomized controlled trials I have done in obstetrics have shown no value or potential harm of interventions, yet when planning this study few clinicians would take part, as they were convinced the intervention worked, told Dr. Shennan. This attitude does not serve the women we care for.
The researchers reported that, although cerclage based on ultrasound resulted in more intervention than cerclage based on obstetric history, there was no significant difference in the incidence of preterm delivery between women managed on the basis of their obstetric history (19/125, 15%) and those managed on the basis of ultrasound exams (18/122, 15%).
In addition, there was no significant difference in the incidence of preterm rupture of membranes, mean gestational age at delivery, or measures of neonatal outcome between the two groups.
These data do not suggest any benefit in replacing historical indications for suture placement with ultrasound surveillance in all women with a history of a preterm birth, the investigators conclude.
Do not assume interventions are good without proper evaluation, Dr. Shennan cautioned. There is little evidence ultrasound scanning-indicated sutures are beneficial.