@2024 Afarand., IRAN
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2019;3(1):13-17
ISSN: 2251-8215 Sarem Journal of Reproductive Medicine 2019;3(1):13-17
Clinical outcomes of the classic McDonald cerclage technique compare with the modified McDonald cerclage technique developed in Sarem Hospital
ARTICLE INFO
Article Type
Original ResearchAuthors
Saremi A. (1)Mirfenderesky A. (*2)
Pooladi A. (1)
(*2) Sarem Fertility & Infertility Research Center (SAFIR), Sarem Women’s Hospital, Tehran, Iran
(1) “Sarem Fertility & Infertility Research Center (SAFIR)” and “Sarem Cell Research Center (SCRC)”, Sarem Women’s Hospital, Tehran, Iran
Correspondence
Article History
Received: August 11, 2017Accepted: November 6, 2017
ePublished: January 4, 2019
ABSTRACT
Aims
The various cerclage techniques with different clinical outcomes are developed for women with cervix incompetence. Among those methods, the McDonald’s cerclage is the most common and preferred technique. The objective of this study was to evaluate and compare the outcomes of the classic McDonald’s cerclage with the modified McDonald’s technique that was developed in Sarem women’s hospital.
Materials & Methods This analytical and historical cohort study was carried out on 105 pregnant women with documented cervical incompetence referred during one year to the Sarem women’s hospital. The patients were divided into two groups depending on the type of cerclage including modified McDonald (n=69) and classic McDonald (n=36) groups. Required information wa collected from the patients’ medical records as well as through telephone call. The data were analyzed using SPSS 22 and GraphPad Prism 6 softwares by T-student, Fisher’s exact and Chi-square tests.
Findings Modified McDonald’s cerclage was performed at higher gestational age compared to classic McDonald’s cerclage (p=0.0001). Despite on the higher preterm labor in the classic McDonald group, the term and preterm delivery rates were not significantly different between two groups (p=0.0601). There was a significant difference in the increase of cervical length following modified McDonald’s cerclage than classic McDonald’s cerclage (p=0.0257) and the patients in modified McDonald’s cerclage group showed a higher cervical length change after cerclage than the other group.
Conclusion Although there are no differences in preterm labor outcome between the two methods, the modified McDonald’s cerclage is a better treatment option because of the possibility to generate a longer cervical length compared to the classic McDonald’s method.
Materials & Methods This analytical and historical cohort study was carried out on 105 pregnant women with documented cervical incompetence referred during one year to the Sarem women’s hospital. The patients were divided into two groups depending on the type of cerclage including modified McDonald (n=69) and classic McDonald (n=36) groups. Required information wa collected from the patients’ medical records as well as through telephone call. The data were analyzed using SPSS 22 and GraphPad Prism 6 softwares by T-student, Fisher’s exact and Chi-square tests.
Findings Modified McDonald’s cerclage was performed at higher gestational age compared to classic McDonald’s cerclage (p=0.0001). Despite on the higher preterm labor in the classic McDonald group, the term and preterm delivery rates were not significantly different between two groups (p=0.0601). There was a significant difference in the increase of cervical length following modified McDonald’s cerclage than classic McDonald’s cerclage (p=0.0257) and the patients in modified McDonald’s cerclage group showed a higher cervical length change after cerclage than the other group.
Conclusion Although there are no differences in preterm labor outcome between the two methods, the modified McDonald’s cerclage is a better treatment option because of the possibility to generate a longer cervical length compared to the classic McDonald’s method.
Keywords:
Cervical Cerclage,
McDonald’s Technique,
Modified McDonald’s Technique,
Cervix Incompetence,
Preterm Labor,
Cervical Length,
CITATION LINKS
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[5]Deshpande HG, Ansari AG, Choudhary PS, Madhav CS. A comparative study of modified Shirodkar's cerclage and McDonald's cerclage in cervical incompetence. Indian J Obstet Gynecol Res. 2016;3(2):143-7.
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[7]Richard SJ. Atlas of gynecologic oncology. 2th edition. Boca Raton, Florida: CRC Press; 2005.
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[9] MIsrafil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Ismail K. Cerclage outcome by the type of suture material (COTS): Study protocol for a pilot and feasibility randomised controlled trial. Trials. 2014;15(1):415.
[10]Althuisius S, Dekker G, Hummel P, Bekedam D, Kuik D, Van Geijn H. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length. Ultrasound Obstet Gynecol. 2002;20(2):163-7.
[11] Kimiaei P, Hadafjou A. Efficacy of cerclage on cervical length. Pajouhandeh. 2008;13(1):77-9.
[2]Wood SL, Owen J. Cerclage: Shirodkar, McDonald, and Modifications. Clin Obstet Gynecol. 2016;59(2):302-10.
[3]Corton MM, Leveno K, Bloom S, Spong C. Williams Obstetrics. 24th edition. New York: McGraw-Hill Education; 2014.
[4]Brown R, Gagnon R, Delisle MF, Maternal Fetal Medicine Committee. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2013;35(12):1115-27.
[5]Deshpande HG, Ansari AG, Choudhary PS, Madhav CS. A comparative study of modified Shirodkar's cerclage and McDonald's cerclage in cervical incompetence. Indian J Obstet Gynecol Res. 2016;3(2):143-7.
[6]Baggish M, Karram M. Atlas of pelvic anatomy and gynecologic surgery. 3thedition. Amsterdam: Elsevier; 2011.
[7]Richard SJ. Atlas of gynecologic oncology. 2th edition. Boca Raton, Florida: CRC Press; 2005.
[8]Resnik R, Creasy RK, Iams JD, Lockwood ChJ, Moore MT, Greene MF. Creasy and Resnik's Maternal-fetal medicine: Principles and practice. 7th edition. Amsterdam: Elsevier; 2014.
[9] MIsrafil-Bayli F, Toozs-Hobson P, Lees C, Slack M, Ismail K. Cerclage outcome by the type of suture material (COTS): Study protocol for a pilot and feasibility randomised controlled trial. Trials. 2014;15(1):415.
[10]Althuisius S, Dekker G, Hummel P, Bekedam D, Kuik D, Van Geijn H. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length. Ultrasound Obstet Gynecol. 2002;20(2):163-7.
[11] Kimiaei P, Hadafjou A. Efficacy of cerclage on cervical length. Pajouhandeh. 2008;13(1):77-9.