Cervical Closure Doesn't Reduce Preterm Deliveries
 4 June, 2004

LONDON (Reuters Health) - Among pregnant women at risk for early preterm delivery, holding the cervix closed with ligatures does not substantially reduce the risk, according to a UK study.

Although cervical cerclage, as the strategy is called, has been widely used for 50 years, results of clinical trials have not supported the value of the practice, Professor Kypros H. Nicolaides from Kings College Hospital, London, and colleagues note in this week's issue of The Lancet.

This may have been because patients were deemed to be at risk for preterm delivery based largely on previous occurrences, they suggest. In their study, the investigators used ultrasound to screen 47,123 women and identified 470 with a short cervix that indicated a risk for early delivery.

The team then randomly assigned 253 of these women to have cervical cerclage or no surgery. The aim of the study was to test the theory that cervical cerclage would result in a three-fold reduction in early preterm delivery.

At the end of their study, the authors found that 22 percent of women randomized to cerclage delivered before 33 weeks, compared with 26 percent of the women in the control group. The difference in these rates was not significant statistically, meaning it could have occurred by chance.

The rate of early preterm delivery in both groups was far in excess of the UK average of 1.5 percent, highlighting the efficiency of the ultrasound measurement for identifying high-risk women, the researchers note.

However, they conclude, the findings also show that, "in women with a short cervix at 22 to 24 weeks of gestation, the insertion of a (cervical) suture does not result in a three-fold reduction in the frequency of early preterm delivery."

SOURCE: Lancet, June 5, 2004.