Popular surgery to prevent preterm births poses risks, offers no benefit

A common surgical procedure to prevent the cervix opening during pregnancy – thought to reduce the risk of preterm delivery – was called into question by results of a study published in The Lancet, a British medical journal.

Cervical cerclage (stitching to keep the cervix closed) has been widely used in the past 50 years to prevent early preterm birth. The new study suggests that the procedure – which carries several significant risks and greatly increases health care costs – may not be effective.

Kypros Nicolaides from Kings College Hospital, London, and colleagues used ultrasound screening to identify women with a short cervix (assumed to be at a higher risk of premature delivery) and randomized 250 such women to receive either cervical cerclage or no surgery.

There was little difference in the incidence of premature delivery between the two groups: 22% for those who underwent the procedure versus 26% for those who did not. Nicolaides concluded that the procedure in women with a short cervix “does not substantially reduce the risk of early preterm delivery.”

Risks posed by cervical cerclage include infection both before and after delivery, damage to the cervix during surgery, excessive blood loss, premature rupture of membranes, preterm labor, and permanent narrowing or closure of the cervix (cervical stenosis). In addition, going into labor with the stitching in place can cause tearing of the cervix or uterus.

SOURCES:  “Cervical cerclage for prevention of preterm delivery in women with short cervix: randomised controlled trial,” The Lancet, June 5, 2004.