Surgery to Stop Preterm Delivery Ineffective

Study may settle debate on stitching cervix shut

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HealthDay Reporter

FRIDAY, June 4, 2004 (HealthDayNews) -- A common operation believed to reduce the risk of preterm delivery by sewing the cervix shut during pregnancy seems to make little difference in the outcome, researchers report.

Whether this procedure, called cervical cerclage, is effective has been the topic of debate among physicians for years. Now a new study says the procedure "does not substantially reduce the risk of early preterm delivery."

Cervical cerclage involves using stitches to keep the cervix closed. This method has been used for 50 years as the recommended treatment to prevent preterm delivery. Over the years, cervical cerclage has grown in popularity and is now done often in women who are at risk for giving birth prematurely.

In the study, lead researcher Dr. Kypros Nicolaides from Kings College Hospital, London, and colleagues identified women with a short cervix, which placed them at risk of premature delivery. The research team used ultrasound to identify these women, according to their report in the June 5 issue of The Lancet.

Nicolaides's team identified 253 women at risk for preterm delivery and randomly assigned them to cervical cerclage or no surgery.

The researchers found 22 percent of the women who had cervical cerclage gave birth on or before 33 weeks of pregnancy, compared to 26 percent of the women who did not undergo the procedure. Typically, preterm babies are those who are born before 37 weeks' gestation.

"This study tips the balance in favor of not performing a cerclage," said Dr. Edmund F. Funai, co-chief of the maternal-fetal medicine at Yale University School of Medicine and Yale-New Haven Hospital.

"If there is a benefit to cerclage, it is very modest," Funai added. "We may be performing 50 cerclages to prevent one preterm birth and, like any surgical procedure, there are complications."

Funai said there are many causes for preterm delivery and a cervix problem is only one. Cerclage is probably not the best procedure to deal with all the possibilities that can cause preterm birth, he said.

Funai believes the technique should be reserved for women who have had a history of premature delivery.

For women who have a short cervix, the best procedure is to follow them closely and give them steroids when necessary to prevent problems in the infant, he advised.

Dr. Errol R. Norwitz, an associate professor at Yale University School of Medicine and the associate director of the maternal-fetal medicine, added, "This is a paper that a lot of us have been waiting for."

The study confirms that a shortened cervix is a risk for preterm birth. It also confirms there is no benefit to routine cerclage, he said, although he agrees that women with a history of preterm births may benefit from having it done.

For women at risk of preterm delivery, Norwitz said that bed rest and pelvic rest -- that is, no tampons, no douching, no intercourse -- are often recommended. But there is no proven benefit to these measures, he noted.

Norwitz said that starting steroids early to protect the baby from respiratory distress and bleeding in the heart -- common complications in preterm births -- should be done.

He added that new data shows that giving women at risk for preterm delivery progesterone early in their pregnancy is effective in preventing preterm delivery. "This is the first really exciting data that has come on the horizon," he said.

More information

The National Library of Medicine can tell you about premature babies.

SOURCES: Errol R. Norwitz, M.D., Ph.D., associate professor, obstetrics and gynecology, Yale University School of Medicine, and associate director, maternal-fetal medicine, Yale-New Haven Hospital, New Haven, Conn.; Edmund F. Funai, M.D., assistant professor, obstetrics and gynecology, Yale University School of Medicine, and co-chief, maternal-fetal medicine, Yale-New Haven Hospital, New Haven, Conn.; June 5, 2004, The Lancet

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