ΜΕΤΡΗΣΗ ΤΡΑΧΗΛΟΥ ΜΗΤΡΑΣ

ΚΟΝΤΟΣ ΤΡΑΧΗΛΟΣ /ΟΡΙΣΜΟΣ

Μέχρι πρότινος ειχαμε κατηγοροποιήσει τις γυναίκες σε χαμηλού κινδύνου και υψηλού κινδύνου στο να αξιολογήσουμε εαν ενας τράχηλος είναι κοντός η οχι. Για παράδειγμα θεωρούσαμε οτι για μια γυναίκα χαμηλού κινδύνου ενας τράχηλος < 15 χιλ θεωρούταν  κοντός ενω αντίθετα για μια γυναίκα υψηλού κινδύνου  ενας τράχηλος < 25 χιλοστα θεωρούταν κοντός.

 

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ΣΗΜΕΡΑ ΛΑΜΒΑΝΩΝΤΑΣ ΥΠΟΨΙΝ ΤΑ ΠΑΡΑΚΑΤΩ

1 Το EDITORIAL  toy Roberto Romero
 EDITORIAL Ultrasound in Obstetrics & GynecologyVolume 30, Issue 5, pages 675–686, October 2007


2 Την  ΠΡΩΤΗ ΜΕΓΑΛΗ  ΜΕΤΑ ΑΝΑΛΥΣΗ
Romero R, Nicolaides K, Conde-Agudelo A, et al
American Journal of Obstetrics & Gynecology
Volume 206, Issue 2 , Pages 124.e1-124.e19, February 2012
(ΟΡΙΟ ΚΟΝΤΟΥ ΤΡΑΧΗΛΟΥ 10-20 ΧΙΛ

3 ΤΗΝ ΜΕΛΕΤΗ ΤΗΣ  Emily A. DeFranco
   Preterm Birth, Short Cervix,and Transvaginal Ultrasound: A New Urgency
The Female Patient Supplement OCTOBER 2009
Emily A. DeFranco, DO, is Assistant
Professor, Maternal-Fetal Medicine,
Department of Obstetrics and Gynecology,
University of Cincinnati College of
Medicine, OH.
ΟΡΙΟ ΚΟΝΤΟΥ ΤΡΑΧΗΛΟΥ 28 ΧΙΛ
pdf10


4  ΤΗΝ ΜΕΛΕΤΗ  Jay D. Iams, MD
  Prediction and Early Detection of Preterm Labor
Jay D. Iams, MD
OBSTETRICS & GYNECOLOGY
VOL. 101, NO. 2, FEBRUARY 2003 0029-7844/03/$30.00
© 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
ΟΡΙΟ ΚΟΝΤΟΥ ΤΡΑΧΗΛΟΥ 25 ΧΙΛ
pdf12


5 ΤΟ ΠΡΩΤΟΚΟΛΛΟ  American College of Radiology
ACR Appropriateness Criteria®
ΟΡΙΟ ΚΟΝΤΟΥ ΤΡΑΧΗΛΟΥ 30 ΧΙΛ

ΘΕΩΡΟΥΜΕ ΟΤΙ ΟΠΟΙΑΔΗΠΟΤΕ ΓΥΝΑΙΚΑ ΜΕ ΟΠΟΙΟΔΗΠΟΤΕ ΙΣΤΟΡΙΚΟ ΚΑΙ  ΜΕ ΜΕΤΡΗΣΙΜΟ ΕΝΔΟΚΟΛΠΙΚΑ ΜΗΚΟΣ ΤΡΑΧΗΛΟΥ < 25 ΧΙΛ ΕΧΕΙ ΚΟΝΤΟ ΤΡΑΧΗΛΟ ΠΟΥ ΑΝΤΙΣΤΟΙΧΕΙ  ΣΤΗΝ 10 ΕΚΑΤΟΣΤΙΑΙΑ ΘΕΣΗ   . ΚΑΘΕ ΤΕΤΟΙΑ ΓΥΝΑΙΚΑ ΥΠΟΧΡΕΩΤΙΚΑ ΜΠΑΙΝΕΙ ΣΕ ΣΤΕΝΗ ΠΑΡΑΚΟΛΟΥΘΗΣΗ

ΕΧΕΙ ΣΗΜΑΣΙΑ Η ΠΑΡΟΥΣΙΑ ΤΟΥ  FUNNELING ΑΣΧΕΤΩΣ ΝΗΚΟΣ ΤΡΑΧΗΛΟΥ?

Does the presence of a funnel increase the risk of adverse
perinatal outcome in a patient with a short cervix?
emvrio25
The disruption of the internal os, as documented by funneling, is a significant risk
factor for adverse perinatal outcome (ie, preterm labor, chorioamnionitis, abruption, rupture of
the membranes, and serious neonatal morbidity and mortality
Prediction and Early Detection of Preterm Labor
Jay D. Iams, MD

SUMMARY
In this uncertain situation, the American College
of Radiology recommends (and I agree) that the
obstetrician should obtain a transvaginal ultrasound
measurement of the cervix with an empty bladder. A
measurement of more than 25 mm in a patient without
symptoms and a negative risk history allows the obstetrician
to reassure the patient that the risk of preterm
birth is not increased. The American College of Radiology
uses 30 mm as the threshold of reassurance



ΠΡΩΤΟΚΟΛΛΟ

ΣΕ ΠΕΡΙΠΤΩΣΗ ΚΟΝΤΟΥ ΤΡΑΧΗΛΟΥ ΔΗΛΑΔΗ ΜΕ ΜΗΚΟΣ  < 25 ΧΙΛ , ΣΕ ΚΑΘΕ ΕΓΚΥΟ ΑΝΕΞΑΡΤΗΤΟΥ ΙΣΤΟΡΙΚΟΥ,  ΜΕΤΑΞΥ 16-24 ΕΒΔΟΜΑΔΕΣ ΚΥΗΣΗΣ  ΣΥΝΙΣΤΑΤΑΙ
1 ΛΗΨΗ ΠΡΟΓΕΣΤΕΡΟΝΗΣ Α) CRINONE /VASCLOR  1 ΕΦΑΡΜΟΣΤΗ ΚΑΘΕ ΠΡΩΙ ΜΕΧΡΙ ΤΙΣ 34 ΕΒΔΟΜΑΔΕΣ  
                                                 
2 ΜΕΤΡΗΣΗ ΤΡΑΧΗΛΟΥ ΚΑΘΕ ΕΒΔΟΜΑΔΑ ΑΡΧΙΚΑ ΚΑΙ ΜΕΤΑ ΚΑΘΕ 2 ΕΒΔΟΜΑΔΕΣ ΕΑΝ Η ΚΑΤΑΣΤΑΣΗ ΣΤΑΘΕΡΟΠΟΙΗΘΕΙ ΜΕΧΡΙ ΤΙΣ 34 ΕΒΔΟΜΑΔΕΣ


3 ΑΠΟΦΥΓΗ ΕΡΓΑΣΙΑΣ /ΑΡΣΗΣ ΒΑΡΟΥΣ /ΣΕΞΟΥΑΛΙΚΗΣ ΕΠΑΦΗΣ


4 ΛΗΨΗ ΚΟΡΤΙΖΟΝΗΣ ΚΑΤΑ ΤΗΝ ΚΡΙΣΗ ΤΟΥ ΘΕΡΑΠΩΝΤΑ ΙΑΤΡΟΥ

5 ΑΠΟΦΑΣΗ ΓΙΑ ΠΕΡΙΔΕΣΗ

                                                     Α) ΣΕ ΓΥΝΑΙΚΕΣ ΥΨΗΛΟΥ ΚΙΝΔΥΝΟΥ ΧΩΡΙΣ ΝΑ ΥΠΑΡΧΕΙ ΜΕΤΑΒΟΛΗ ΣΤΟ ΜΗΚΟΣ /ΠΡΟΗΓΟΥΜΕΝΟ ΙΣΤΟΡΙΚΟ ΑΠΟΒΟΛΗΣ Β ΤΡΙΜΗΝΟΥ ΣΥΝΙΣΤΑΤΑΙ ΣΤΕΝΗ ΠΑΡΑΚΟΛΟΥΘΗΣΗ ΑΠΟ ΤΗΝ 14 ΕΒΔΟΜΑΔΑ ΚΑΙ ΚΑΘΕ 10 ΜΕΡΕΣ .ΕΑΝ Ο ΤΡΑΧΗΛΟΣ ΕΙΝΑΙ < 25 ΧΙΛ ΣΥΝΙΣΤΑΤΑΙ ΑΜΕΣΩΣ ΛΗΨΗ ΦΥΣΙΚΗΣ ΠΡΟΓΕΣΤΕΡΟΝΗΣ .ΕΑΝ Ο ΤΡΑΧΗΛΟΣ ΠΕΣΕΙ < 15 ΧΙΛ ΣΥΖΗΤΑΜΑΙ ΓΙΑ ΠΕΡΙΔΕΣΗ ΤΡΑΧΗΛΟΥ ΥΠΟ ΠΡΟΥΠΟΘΕΣΕΙΣ
                                                    Β)ΣΕ ΓΥΝΑΙΚΕΣ ΧΑΜΗΛΟΥ ΚΙΝΔΥΝΟΥ ΟΤΑΝ ΥΠΑΡΧΕΙ ΜΕΤΑΒΟΛΗ  ΣΤΟ ΜΗΚΟΣ ΤΡΑΧΗΛΟΥ(Τραχηλος < 10 χιλ   )
                                                    Γ) ΣΕ ΔΙΔΥΜΕΣ ΚΥΗΣΕΙΣ ΚΑΙ ΧΩΡΙΣ ΙΣΤΟΡΙΚΟ ΑΠΟΒΟΛΗΣ Β ΤΡΙΜΗΝΟΥ ΔΕΝ ΣΥΝΙΣΤΑΤΑΙ ΠΕΡΙΔΕΣΗ ΠΡΟΛΗΠΤΙΚΑ /ΕΚΤΟΣ ΕΑΝ ΥΠΑΡΧΕΙ ΡΑΓΔΑΙΑ ΜΕΤΑΒΟΛΗ ΣΤΟ ΜΗΚΟΣ
                                                   Δ) ΣΕ ΜΗΤΕΡΕΣ ΜΕ ΣΥΓΓΕΝΗ ΑΝΩΜΑΛΙΑ (ΔΙΚΕΡΗ/ΔΙΘΑΛΑΜΗ ) ΣΥΝΙΣΤΑΤΑΙ ΠΕΡΙΔΕΣΗ ΜΟΝΟ ΣΕ ΠΕΡΙΠΤΩΣΗ ΜΕΤΑΒΟΛΗΣ ΜΗΚΟΥΣ ΤΡΑΧΗΛΟΥ /ΤΡΑΧΗΛΟΣ < 10 ΧΙΛ  Η ΠΡΟΗΓΟΥΜΕΝΟ ΙΣΤΟΡΙΚΟ 


ΚΟΝΤΟΣ ΤΡΑΧΗΛΟΣ ΒΙΒΛΙΟΓΡΑΦΙΑ

1  †,* EDITORIAL
pdf 7
ΣΕ ΑΥΤΟ ΤΟ EDITORIAL  Ο R ROMERO  ΣΥΜΦΩΝΕΙ ΠΛΕΟΝ ΟΤΙ ΕΧΕΙ ΑΠΟΔΗΧΤΕΙ Ο ΡΟΛΟΣ ΤΗΣ ΠΡΟΓΕΣΤΕΡΟΝΗΣ ΣΤΗΝ ΠΡΟΛΗΨΗ ΤΟΥ ΠΡΟΩΡΟΥ ΤΟΚΕΤΟΥ ΚΑΙ  ΠΡΟΙΔΕΑΖΕΙ ΓΙΑ ΤΟ CUT OFF ΟΡΙΟ ΤΟΥ ΜΗΚΟΥΣ  ΠΟΥ ΠΡΕΠΕΙ ΝΑ ΧΡΗΣΙΜΟΠΟΙΟΥΜΑΙ ΩΣ ΠΡΟΣ ΤΗΝ ΧΟΡΗΓΗΣΗ ΤΗΣ  (ΟΡΙΟ 28  χιλ ΓΙΑ ΚΑΘΕ ΓΥΝΑΙΚΑ ΑΝΡΞΑΡΤΗΤΟΥ ΙΣΤΟΡΙΚΟΥ)
Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment
1. Roberto Romero
Ultrasound in Obstetrics & Gynecology
Volume 30, Issue 5, pages 675–686, October 2007
Evidence suggests that the administration of vaginal progesterone47, 61 and 17 alpha-hydroxyprogesterone caproate95 may be beneficial in patients with a short cervix or with clinically diagnosed cervical insufficiency217. However, the results of the most recent and promising randomized clinical trials47, 61, in which vaginal progesterone was administered to women with a sonographic short cervix, indicate that progesterone works in a subset of patients. For example, in the trial sponsored by The Fetal Medicine Foundation47, the overall reduction of preterm birth in women with a cervical length of ≤ 15 mm was 44%. However, in women with an extremely short cervix (< 5 mm), progesterone administration was less effective (K. H. Nicolaides, pers. comm.). Why? One explanation is that women with a very short cervix may have already developed asymptomatic intrauterine infection and in such cases progesterone administration is ineffective. These patients may benefit from treatment with antibiotics and anti-inflammatory agents195. It is also possible that patients with an extremely short cervix have entered the irreversible phase of parturition, and intervention to prolong pregnancy would not be effective.
So far, evidence suggests that vaginal progesterone works in a subset of women with a cervical length ≤ 15 mm. However, the possibility must be considered that progesterone may work in women with a longer cervix. This would be consistent with the study of DeFranco et al.61, which found that women with a cervix of < 28 mm and allocated to progesterone were more likely to deliver after 32 weeks. The implication of such a finding is that progesterone may be effective in more women, as the frequency of a cervical length of ≤ 15 mm is 1.7%47, while that of < 28 mm is about 10%61, 63 (an alternative is to use 25 mm as proposed by Iams et al.).


2) ULTRASOUND IN OBSTETRICS AND GYNECOLOGY

2002 May;19(5):475-7.
Elective cerclage vs. ultrasound-indicated cerclage in high-risk pregnancies.
To MS, Palaniappan V, Skentou C, Gibb D, Nicolaides KH.
Source
Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, L
One group was managed by the placement of an elective cerclage at 12-16 weeks and the other group had transvaginal ultrasound examinations of the cervix at 12-15+6, 16-19+6, and 20-23+6 weeks and cervical cerclage was carried out if the cervical length was 25 mm or less. CONCLUSION: In women at increased risk of spontaneous mid-trimester or early preterm delivery, a policy of sonographic surveillance followed by cervical cerclage in those with a short cervix reduces the need for surgical intervention without significantly increasing adverse pregnancy outcome.

3) ΔΥΔΙΜΕΣ ΚΥΗΣΕΙΣ  Η ΠΕΡΙΔΕΣΗ ΟΧΙ ΜΟΝΟ ΔΕΝ ΒΟΗΘΑΕΙ  ΑΛΛΑ ΑΝΤΙΘΕΤΩΣ ΜΠΟΡΕΙ ΝΑ ΔΗΜΙΟΥΡΓΗΣΕΙ ΠΡΟΒΛΗΜΑ


Α) Newman RB, Krombach RS, Myers MC, McGee DL.Effect of cerclage on obstetrical outcome in twin gestations with a shortened cervical length.
) AJOG  2002 Apr;186(4):634-40.Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, 29425, USA.CONCLUSION: Midtrimester cerclage does not alter the risks of prematurity associated with a shortened cervical length in twin gestations.

Β) Berghella V, Obido AO, To MS, Rust OA, Althiusius SM. Cerclage for short cervix on ultrasound: meta-analysis of trials using individual patient-level data. Obstet Gynecol 2005;106:181–9. .CONCLUSION:
 In the 49 sets of twins and TVU CL <25 mm reported so far in randomised trials, cerclage was associated with a much higher (75 versus 36%) incidence of PTB <35 weeks compared with controls (RR 2.15, 95% CI 1.15–4.01) and eight more neonates died in the cerclage compared with the no cerclage group.24 Therefore, cerclage should not be used in twin pregnancy for short TVU CL.

4) H ΚΛΑΣΙΚΗ ΜΕΛΕΤΗ ΑΠΟ ΤΟ FMF/ FONSECA  
 Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH; Fetal Medical Foundation Second Trimester Screening Group. Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med2007;357:462–9.
24 620 asymptomatic women were screened at 22 (20–25) weeks by TVU. Of these, 250 (24 with twins) were identified to have a CL ≤15 mm and randomised to 200 mg vaginal progesterone or placebo every night from 24 to 34 weeks.11 Progesterone was associated with a reduction in the risk of spontaneous delivery before 34 weeks of 44.2% (hazard ratio for progesterone, 0.57; 95% CI 0.35–0.92; P= 0.02). Neonatal outcomes were not reported. Based on this trial, vaginal progesterone seems effective in preventing PTB in women with CL ≤15 mm, no matter what their history

.
5) Η ΠΡΩΤΗ ΜΕΓΑΛΗ  ΜΕΤΑ ΑΝΑΛΥΣΗ
Romero R, Nicolaides K, Conde-Agudelo A, et al
American Journal of Obstetrics & Gynecology
Volume 206, Issue 2 , Pages 124.e1-124.e19, February 2012

Vaginal progesterone in women with an asymptomatic sonographic short cervix in the midtrimester decreases preterm delivery and neonatal morbidity: a systematic review and metaanalysis of individual patient data

The IPD metaanalysis included RCTs in
which asymptomatic women with a sonographic
short cervix (CL < 25 mm) in the
midtrimester were randomly allocated to receive
vaginal progesterone or placebo/no
treatment for the prevention of preterm
birth.
RESULTS  Vaginal progesterone administration to
asymptomatic women with a sonographic
short cervix in the midtrimester was associated
with a significant 42% reduction in
the rate of preterm birth _33 weeks (primary
outcome);

In patients with a
twin gestation, there was a nonsignificant
trend toward reduction of the rate of preterm
birth < 33 weeks’ gestation and a significant
reduction in the frequency of
composite neonatal morbidity/mortality.
The reduction in the rates of preterm birth
< 33 weeks and composite neonatal morbidity
and mortality was observed in
women with and without previous spontaneous
preterm birth. No difference in efficacy
was found between doses of 90-100
mg/d or 200 mg/d of vaginal progesterone.
Yet, the only primary
trial that showed a reduction in preterm
birth, RDS, and composite morbidity was
that of Hassan et al,133 which used 90 mg
daily. This represents level-1 evidence of
efficacy. The findings of this IPD metaanalysis
favor the use of a daily vaginal administration
of 90 mg of progesterone because
it is the lowest dose that reduced the
risk of preterm birth _33 weeks and neonatal
morbidity and mortality. Patients
who used 90 mg/d of vaginal progesterone
received it in a gel, whereas patients who
used either 100 or 200 mg/d of vaginal progesterone
received it in a suppository. It is
known that these suppositories melt in the
vagina and there is often loss of the product over the course of a day. The gel is administered
as a bioadhesive preparation applied
against the vaginal wall; therefore, it is less likely to lead to loss of the active
compound.
Implications for practice
The present IPD metaanalysis provides
compelling evidence of the benefit of
vaginal progesterone to prevent preterm
birth and neonatal morbidity/mortality
in women with a sonographic short cervix.
Importantly, there was no evidence
of demonstrable risk. This IPD metaanalysis
indicates that vaginal progesterone
is effective in women with and without
a history of preterm birth and a short
cervix. Therefore, we recommend that
transvaginal sonographic measurement
of cervical length be performed at 19-24
weeks of gestation. Vaginal progesterone
at a dose of 90 mg/d should be considered
for use in patients with a short cervix,
mainly those with a cervical length
between 10-20 mm, from 20-36 6/7
weeks of gestation.
  Randomized controlled trials are
needed to assess the efficacy of vaginal
progesterone for preventing preterm
birth and resultant neonatal morbidity/
mortality in women with twin gestations and a short cervix.Therefore, it appears
that administration of vaginal progesterone
could be an alternative
treatment to cervical cerclage in patients
with a singleton pregnancy, short cervix,
and history of spontaneous preterm
birth for preventing preterm birth and
neonatal morbidity and mortality. Vaginal
progesterone administration does
not carry the risks of anesthesia, the surgical
procedure per se, or some of the
complications attributed to cerclage (ie,
rupture of membranes).16
Additional RCTs are needed to allow better
assessment of the efficacy of vaginal
progesterone in women with twin gestations
and a short cervix, and women with
singleton gestations and a CL < 10 mm.

6 American College of Radiology
ACR Appropriateness Criteria®
pdf8, pdf9

7 ΤΗΣ  Emily A. DeFranco
   Preterm Birth, Short Cervix,and Transvaginal Ultrasound: A New Urgency
The Female Patient Supplement OCTOBER 2009
Emily A. DeFranco, DO, is Assistant
Professor, Maternal-Fetal Medicine,
Department of Obstetrics and Gynecology,
University of Cincinnati College of
Medicine, OH.

pdf 11
8 Jay D. Iams, MD
 Prediction and Early Detection of Preterm Labor
OBSTETRICS & GYNECOLOGY
VOL. 101, NO. 2, FEBRUARY 2003 0029-7844/03/$30.00
© 2003 by The American College of Obstetricians and Gynecologists. Published by Elsevier.
Cerclage to prevent mid-trimester
abortion/preterm birth: A summary
of the evidence
1) Cervical cerclage in women with a sonographic
short cervix (15 mm or less) and at low risk for
preterm delivery (by history) does not reduce the
rate of spontaneous preterm birth.27
2) The effectiveness of cervical cerclage in women with a
sonographic short cervix and at high risk (by history)
for preterm delivery remains controversial.7,9,11,23,99
3) The role of prophylactic cerclage in high-risk patients
without a sonographic short cervix for the prevention
of preterm delivery/mid-trimester abortion (by
history) is unclear.21,50-52,99 While the largest trial
conducted before the introduction of ultrasound
evaluation of the cervix suggested amodest beneficial
effect,52 other trials50,51 and systematic reviews33
before the use of ultrasound have indicated that the
evidence of effectiveness is either weak or
nonexistent.
4) In patients at risk for preterm delivery, serial
sonographic examination of the cervix followed
by cerclage in those who shortened the cervix is a
reasonable alternative to prophylactic placement of
a cerclage based upon uncontrolled studies.4,17,25
5) In one trial, emergency cerclage combined with
indomethacin administration appeared to reduce
the rate of preterm delivery in patients with the
clinical presentation of ‘‘cervical insufficiency.’’102 This evidence indicates that patients with the clinical
presentation of ‘‘acute cervical insufficiency’’ and those
with a previous history consistent with ‘‘cervical insufficiency’’
and progressive shortening of the cervix demonstrated
with ultrasound may benefit from cerclage
placement. However, these conclusions are based on
the results of one randomized clinical trial each.99,102 In
this issue of the Journal, Sakai et al support that the inflammatory
status in the endocervix may be an additional
criteria to identify those patients who could benefit from
cerclage placement and those in which this intervention
may be harmful.53

 


EMERGENCY CERGLACE

Contraindications to Emergency Cervical Cerclage
Absolute contraindications to emergency cerclage are summarized in Table 1. Factors such as placenta previa, a mucopurulent cervical discharge with membrane opacification, fetal membranes prolapsing through the cervical os, and/or intrauterine fetal growth restriction (IUGR) may be regarded as relative contraindications. ACOG supports cervical cerclage placement up to 28 weeks’ gestation (16). However, many practitioners would not recommend emergent cervical cerclage placement beyond the limit of fetal viability (i.e., 24 weeks’ gestation), because the potential for harm likely outweighs the potential benefit (17).
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J Obstet Gynaecol Can. 2005 Feb;27(2):123-9.
2005 Feb;27(2):123-9.
Cervical incompetence and the role of emergency cerclage.
Cockwell HA, Smith GN.Source
Department of Obstetrics and Gynecology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
The KGH data collected and the data available in the literature suggest that emergency cerclage, under ideal circumstances, can significantly prolong pregnancy and increase the chance of viable pregnancy outcome. However, in counselling women about the potential therapeutic benefit of emergency cerclage, the increased risk of chorioamnionitis and its associated risk of fetal inflammatory brain injury, as well as the risk of extending a pregnancy from pre-viability to severe prematurity, should be discussed. A longer-term follow-up than has been carried out here is required for better elucidation of the effect of chorioamnionitis on those infants in childhood and beyond.

Obstet Gynecol. 2003 Mar;101(3):565-9.
Factors associated with success of emergent second-trimester cerclage.
Terkildsen MF, Parilla BV, Kumar P, Grobman WA.
Source
Sections of Maternal-Fetal Medicine and Pediatrics, Northwestern University Medical School, Northwestern University, 333 East Superior Street, Chicago, IL 60611, USA.
CONCLUSION:
Nulliparity, the presence of membranes prolapsing beyond the external cervical os, and gestational age less than 22 weeks at cerclage placement are associated with decreased chance of delivery at or after 28 weeks after emergent cerclage; these factors may be used to help counsel patients considering the procedure.

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