Background
Cervical cerclage placement has been shown to benefit women who have cervical insufficiency;
however, the best type of suture to use for transvaginal cerclage placement is unknown.
Objective
The objective of the study was to evaluate the association between transvaginal cerclage
suture thickness and pregnancy outcomes.
Study Design
This was a retrospective cohort study of women with a singleton, nonanomalous gestation
who underwent history-, ultrasound-, or physical examination–indicated transvaginal
cerclage at a single tertiary care center (2013–2016). The primary outcome was gestational
age at delivery. Secondary outcomes included preterm birth less than 34 weeks, chorioamnionitis,
neonatal intensive care unit admission, and composite neonatal morbidity. Baseline
characteristics and outcomes were compared by thickness of suture material: thick
5 mm braided polyester fiber (Mersilene tape) vs thin polyester braided thread (Ethibond)
or polypropylene nonbraided monofilament (Prolene) with selection of suture type at
the discretion of the provider. The association between thick suture and gestational
age at delivery was estimated using Cox proportional hazard regression. Multivariable
logistic regression was used to estimate the association between thick suture and
the secondary outcomes. Effect modification of cerclage indication was also assessed.
Results
A total of 203 women met inclusion criteria: 120 with thick suture (59%) and 83 with
thin suture (41%). Of these, 130 women had history-indicated, 35 had ultrasound-indicated,
and 38 had examination-indicated cerclages. Compared with women who had thin suture,
women with thick suture were more likely to have had a history- or ultrasound-indicated
cerclage, rather than examination-indicated cerclage, and more likely to have had
a Shirodkar or cervicoisthmic approach, rather than McDonald. Women with thick suture
were also more likely to have received progesterone and had placement at earlier gestational
age, but there were no differences in cervical examination at placement. After adjusting
for confounding factors, thick suture was associated with longer pregnancy duration
among women with ultrasound-indicated cerclage (adjusted hazard risk, 0.61, 95% confidence
interval, 0.41–0.91) and examination-indicated cerclage (adjusted hazard risk, 0.30,
95% confidence interval, 0.15–0.58) but not with history-indicated cerclage (adjusted
hazard risk, 1.27, 95% confidence interval, 0.83–1.94). Thick suture was also associated
with lower odds of preterm birth <34 weeks, chorioamnionitis, and neonatal intensive
care unit admission, compared with thin suture.
Conclusion
Thick, compared with thin suture, for transvaginal cervical cerclage, was associated
with longer duration of pregnancy among women with ultrasound- and examination-indicated
cerclages and lower odds of chorioamnionitis and neonatal intensive care unit admission
among all women, regardless of cerclage indication.
Key words
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Article info
Publication history
Accepted:
October 2,
2019
Received in revised form:
September 25,
2019
Received:
June 4,
2019
Footnotes
This work was supported, in part, by grant R01-MD011609 (to Dr Manuck).
The authors report no conflict of interest.
Cite this article as: Batterbee AN, Pfister A, Manuck TA. Suture thickness and transvaginal cervical cerclage outcomes. Am J Obstet Gynecol MFM 2019;1:100056.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
