Nordstjernen
23-06-2004, 00:02
June 7, 2004 — Short cervix identifies women at high risk for preterm delivery, but cerclage does not significantly reduce the risk, according to the results of a randomized trial published in the June 5 issue of The Lancet.
"Cervical cerclage has been widely used in the past 50 years to prevent early preterm birth and its associated neonatal morbidity and mortality," write Meekai S. To and colleagues from the Fetal Medicine Foundation Second Trimester Screening Group. "Results of randomised trials have not generally lent support to this practice, but this absence of benefit may be due to suboptimum patient selection."
The investigators measured cervical length in 47,123 women. Of 470 women with cervical length 15 mm or less, 253 (54%) of these women participated in the study and were randomized to cervical cerclage or to expectant management. The primary outcome was the frequency of preterm delivery, defined as delivery before 33 completed weeks (231 days) of pregnancy.
Preterm delivery occurred in 22% (28 of 127) in the cerclage group and in 26% (33 of 126) in the control group (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.54-1.31; P = .44). These proportions are far higher than the U.K. average for risk of premature delivery, which is 1.5%. Both groups were similar in perinatal and maternal morbidity and mortality.
In designing this study, the investigators predetermined that a threefold reduction in preterm delivery was necessary to justify the introduction of routine screening by transvaginal sonography, followed by cervical cerclage in those with a short cervix. However, they acknowledged that a lesser reduction in early preterm delivery might still be beneficial because of the adverse medical and economic consequences of prematurity.
"The insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery," says senior author Kypros H. Nicolaides, MD, from Kings College Hospital in London, U.K., in a news release. "Routine sonographic measurement of cervical length at 22-24 weeks identifies a group at high risk of early preterm birth."
The Fetal Medicine Foundation and the National Health Service South Thames Research and Development Committee funded this study. Dr. Nicolaides is the Director of the Fetal Medicine Foundation.
Lancet. 2004;363:1849-1853
Er det noen som vet om det er noen forskjell på "bare" kort livmorhals og en, hva skal man si, ikke-fungerende livmorhals, eller om det går ut på det samme?
Har en venninne med cerclage, pga at livmorhalsen flater ut for tidlig.
Så lurer jeg på om dette er noe som vil gjelde henne og hennes livmorhals som er "inkompetent" eller om den kanskje bare gjelder de som har altfor korte.
"Cervical cerclage has been widely used in the past 50 years to prevent early preterm birth and its associated neonatal morbidity and mortality," write Meekai S. To and colleagues from the Fetal Medicine Foundation Second Trimester Screening Group. "Results of randomised trials have not generally lent support to this practice, but this absence of benefit may be due to suboptimum patient selection."
The investigators measured cervical length in 47,123 women. Of 470 women with cervical length 15 mm or less, 253 (54%) of these women participated in the study and were randomized to cervical cerclage or to expectant management. The primary outcome was the frequency of preterm delivery, defined as delivery before 33 completed weeks (231 days) of pregnancy.
Preterm delivery occurred in 22% (28 of 127) in the cerclage group and in 26% (33 of 126) in the control group (relative risk [RR] = 0.84; 95% confidence interval [CI], 0.54-1.31; P = .44). These proportions are far higher than the U.K. average for risk of premature delivery, which is 1.5%. Both groups were similar in perinatal and maternal morbidity and mortality.
In designing this study, the investigators predetermined that a threefold reduction in preterm delivery was necessary to justify the introduction of routine screening by transvaginal sonography, followed by cervical cerclage in those with a short cervix. However, they acknowledged that a lesser reduction in early preterm delivery might still be beneficial because of the adverse medical and economic consequences of prematurity.
"The insertion of a Shirodkar suture in women with a short cervix does not substantially reduce the risk of early preterm delivery," says senior author Kypros H. Nicolaides, MD, from Kings College Hospital in London, U.K., in a news release. "Routine sonographic measurement of cervical length at 22-24 weeks identifies a group at high risk of early preterm birth."
The Fetal Medicine Foundation and the National Health Service South Thames Research and Development Committee funded this study. Dr. Nicolaides is the Director of the Fetal Medicine Foundation.
Lancet. 2004;363:1849-1853
Er det noen som vet om det er noen forskjell på "bare" kort livmorhals og en, hva skal man si, ikke-fungerende livmorhals, eller om det går ut på det samme?
Har en venninne med cerclage, pga at livmorhalsen flater ut for tidlig.
Så lurer jeg på om dette er noe som vil gjelde henne og hennes livmorhals som er "inkompetent" eller om den kanskje bare gjelder de som har altfor korte.