Table 9 Impact of cervical cerclage on stillbirth and perinatal outcomes

Drakeley et al. 2003 [92]

Netherlands, France, UK, South Africa.

Meta-analysis (Cochrane). 6 RCTs included (N = 2059 women).

Assessed the effects of cervical cerclage (intervention) vs. no cerclage (controls).

PMR: RR = 0.80 (95% CI: 0.48–1.36) [NS]

[24/1035 vs. 31/1024 in intervention vs. control groups, respectively.

Jorgensen et al. 2007 [100]

Netherlands, USA, Nigeria, UK, France, Hungary, Norway, Italy, Belgium, Zimbabwe, South Africa, Iceland, Ireland, Canada, Brazil Slovenia, Greece and Chile.

Meta-analysis. 7 RCTs included (N = 2091 women).

Assessed the effects of cervical cerclage (intervention) vs. no cerclage (controls).

(Singleton gestations) Pregnancy loss or death before hospital discharge: OR = 0.81 (95% CI: 0.60–1.10) [NS]

(Multiple gestations) Pregnancy loss or death before hospital discharge: OR = 5.88 (95% CI: 1.14–30.19).

Intervention studies

Blair et al. 2002 [101]

West Indies.

RCT. Pregnant women (N = 50) with cervical incompetence.

Compared the impact of cervical cerclage between inpatient care for 3 days post-procedure, spending 3 days in hospital post-procedure (intervention) vs. outpatient bed rest (controls). Both groups given salbutamol tablets postoperatively for tocolysis.

Live birth rate: 20/23 vs. 18/23 (86.9% vs. 78.3%) in intervention vs. control groups, respectively [NS]

Jaswal et al. 2006 [198]

India.

Quasi-RCT. Pregnant women (N = 37) being expectantly managed for placenta previa.

Compared the impact of cervical cerclage (intervention) versus no cerclage (controls).

PMR: 0/18 vs. 8/19 in intervention vs. control groups, respectively (P < 0.01).

Observational studies

Debbs et al. 2007 [104]

USA.

Retrospective case series. Pregnant women (N = 75) with negative evaluation for recurrent pregnancy loss and ≥ 1 previous unsuccessful transvaginal cerclage.

Assessed the impact of transabdominal cerclage on birth outcomes.

Live birth rate: 96% after transabdominal cerclage.

Fick et al. 2007 [102]

USA.

A cohort study. Pregnant women (N = 88 women; N = 9 pregnancies) with transabdominal cerclage.

Compared the live birth rate before and after transabdominal cerclage.

Live birth rate: 93% vs. 18% after vs. cerclage, respectively; P < 0.001).

Gesson-Paute et al. 2007 [103]

France.

Retrospective study. Transabdominal cerclages (N = 12) performed from 1988–2005.

Compared the live birth rate during the period where transabdominal cerclage was performed vs. the pre-cerclage period.

Live birth rate: 93% vs. 17% after vs. before cerclage, respectively.