Abstract
Introduction: The optimal management of women presenting with premature cervical dilatation and exposed fetal membranes (CDEM) remains uncertain and controversial. This systematic review forms part of a larger broad systematic review aiming to summarise all existing evidence relating to the management of this condition to inform and support women, their families and healthcare professionals in decision-making.
Methods: Five databases were searched according to a prospectively published protocol (CRD42021286275). Inclusion criteria was met if the population included women with CDEM and reported clinical outcomes. Searches identified 3165 Abstracts, 389 full texts were reviewed and 172 studies were eligible for inclusion across 5 comparison groups. 22 papers were included for comparison of emergency cervical cerclage (ECC) and expectant management (EM). 102 observational ECC studies with no comparison group were separately analysed to improve understanding of complication rates of ECC.
Results: Women receiving ECC are significantly less likely to experience pregnancy loss than those receiving EM (All pregnancies: RR 0.43 95% CI 0.31–0.59, 14 studies, high risk of bias) and remain pregnant for longer (mean difference 38.82 days 95% CI 24.68–52.95, 11 studies). However, with women receiving ECC remaining pregnant for a mean of 60.5 days (SD 21.2) survival is related to gestation at presentation. Analysis of studies with no comparison group is ongoing.
Discussion: ECC appears to reduce the risk of pregnancy loss although the quality of evidence is poor and reporting of complications limited. A prospective randomised trial remains imperative for understanding the role of ECC in preventing pregnancy loss in this condition.
Methods: Five databases were searched according to a prospectively published protocol (CRD42021286275). Inclusion criteria was met if the population included women with CDEM and reported clinical outcomes. Searches identified 3165 Abstracts, 389 full texts were reviewed and 172 studies were eligible for inclusion across 5 comparison groups. 22 papers were included for comparison of emergency cervical cerclage (ECC) and expectant management (EM). 102 observational ECC studies with no comparison group were separately analysed to improve understanding of complication rates of ECC.
Results: Women receiving ECC are significantly less likely to experience pregnancy loss than those receiving EM (All pregnancies: RR 0.43 95% CI 0.31–0.59, 14 studies, high risk of bias) and remain pregnant for longer (mean difference 38.82 days 95% CI 24.68–52.95, 11 studies). However, with women receiving ECC remaining pregnant for a mean of 60.5 days (SD 21.2) survival is related to gestation at presentation. Analysis of studies with no comparison group is ongoing.
Discussion: ECC appears to reduce the risk of pregnancy loss although the quality of evidence is poor and reporting of complications limited. A prospective randomised trial remains imperative for understanding the role of ECC in preventing pregnancy loss in this condition.
| Original language | English |
|---|---|
| Article number | 165 |
| Journal | BJOG: An International Journal of Obstetrics & Gynaecology |
| Volume | 130 |
| Issue number | S1 |
| DOIs | |
| Publication status | Published - 11 Apr 2023 |
| Event | British Maternal and Fetal Medicine Society and MacDonald Obstetric Medicine Society joint conference 2022 - Millennium Point, Birmingham, United Kingdom Duration: 16 Nov 2022 → 18 Nov 2022 |