The following is a summary of “Perioperative complications of a transvaginal cervical cerclage in singleton pregnancies: a systematic review and meta-analysis,” published in the MAY 2023 issue of Obstetrics and Gynecology by Dijk, et al.
For a study, researchers sought to evaluate the perioperative complications of transvaginal cervical cerclage and compare the characteristics based on the indication for cerclage in singleton pregnancies. The study aimed to provide a pooled risk analysis and address the limitations of previous studies underpowered to conclude the procedure’s safety.
Multiple databases, including Ovid MEDLINE, Ovid Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform, was searched from inception to April 2020. The study included randomized controlled trials, retrospective and prospective observational cohort studies that reported complications associated with history-indicated cerclage, ultrasound-indicated cerclage, or physical examination-indicated cerclage. Studies were eligible if they provided original data on adverse events occurring during surgery or within 24 hours post-surgery. The Cochrane risk of bias tool for randomized controlled trials and the Newcastle-Ottawa scale for cohort and case-control studies were used to assess the quality of included studies.
Pooled risk assessment was conducted using the meta and meta for R (studio) packages, version 4.0.3. From the initial search, a total of 2,328 potential studies were identified. The final analysis included three randomized controlled trials, three prospective cohort studies, and 38 retrospective cohort studies. The analysis involved 4,511 women with singleton gestations, of whom 1,561 (34.6%) underwent history-indicated cerclage, 1,348 (29.9%) underwent ultrasound-indicated cerclage, and 1,549 (33.3%) underwent physical examination-indicated cerclage. Physical examination-indicated cerclage had the highest incidence of perioperative complications, particularly hemorrhage (2.3%; 95% CI, 0.0-7.6) and preterm premature rupture of membranes (2.5%; 95% CI, 0.91-4.5). History-indicated cerclage had the fewest complications, ranging from 0.0% of preterm premature rupture of membranes (95% CI, 0.0-1.7) to 0.9% of hemorrhage (95% CI, 0.0-7.9).
Ultrasound-indicated cerclage showed a higher incidence of hemorrhage (1.4%; 95% CI, 0.0-4.1), lacerations (0.6%; 95% CI, 0.0-3.1), and preterm premature rupture of membranes (0.3%; 95% CI, 0.0-0.8).
The study found that physical examination-indicated cerclage had the highest risk of perioperative complications compared to ultrasound- and history-indicated cerclage in singleton pregnancies. However, the documentation of complications in published literature was inadequate, and information regarding the timing of complications (perioperative or later in pregnancy) was lacking. The study emphasized the urgent need for a standardized reporting policy for complications in both cohort studies and randomized controlled trials focusing on cerclage.
Source: ajog.org/article/S0002-9378(22)00836-5/fulltext