VP52.16: Modified Wurm transvaginal cerclage to prevent preterm birth

Le résumé fourni par la source

Our aim was to compare the modified Wurm cerclage technique to MacDonald cervical cerclage in prevention of preterm birth in high-risk women. This was a prospective case-control study of all women with singleton pregnancies undergoing history or ultrasound-indicated transvaginal cervical cerclage (2017-2019). Two cerclage techniques were evaluated. In the modified Wurm technique using monofilament material Prolene®, two circumferential sutures are placed through the cervix aiming to achieve a higher cerclage placement without the need for bladder dissection. Outcomes were compared to women undergoing a standard MacDonald technique (single stitch with tape-Mersilene® or monofilament-Ethilon® using diamond-type insertion). Outcomes included gestational age at delivery and adverse events. A multiple logistic regression analysis was performed to identify differences between the two groups with a 0.05 level of significance. 123 patients were included: 28 (22.8%) had modified Wurm and 95 (77.2%) had MacDonald cerclage. Other than ethnicity, demographics were comparable. The rate of spontaneous preterm birth (SPTB) <37 weeks' gestation was similar between the two techniques, even after adjusting for ethnicity (25% vs. 29.5%; aOR 0.81; 95% CI, 0.30-2.20, table 1). Cervical length below cerclage was 16.7mm vs. 17.0mm, p = 0.8. There was no significant difference in complications related to placement or removal. The perinatal loss rate and composite neonatal morbidity/mortality was comparable between the two groups (7.1% vs 6.3%; p = 0.58 and 11.5% vs. 11.4%; p = 0.61 respectively). This study does not show any significant difference in rates of SPTB or adverse perinatal outcomes between modified Wurm versus MacDonald cerclage techniques. A randomised trial is needed to evaluate the outcomes of different cerclage techniques. VP52.16: Table 1.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.