Speciality
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Obstetric
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Incompetent Shirodkar Suture

   

  • (b)
    Cervical length at 23 weeks of gestation: The value of Shirodkar suture for the short cervix. 

    VCG Heath, AP Souka, I Erasmus (King’s College Hosp
    Med School, London): 

    Ultrasound Obstet Gynecol; 12 : 318-322, 1998.

        


    In the second article from King’s College Hosp Med School, London, authors conclude that women with a cervical length of 15mm or less at 23 weeks gestation have a more than 50% chance of spontaneous delivery before 32 weeks. Inserting Shirodkar suture in these women may greatly reduce the risk of early delivery. This is a comment from Dr. Thomas H Kirschbaum (Editor).

        


    In these 2 confusing articles, the King’s College Hospital group use a prospective but uncontrolled study to make the case for cerclage in women with reduced cervical length at 22-24 weeks gestation to prevent preterm delivery. They have not identified the controls based on an intent to treat by cerclage, but management rests with individual doctors who likely differ in skill and expertise. Also the decision for surgery is not controlled. Hence another large trial will be required of enrolled patients because even with repeated pregnancy losses, about 3/4th of such women will have spontaneously successful pregnancies without surgical intervention. Editor also comments that funneling of the cervix is of little value in predicting preterm
    labour.

        

      



 

 

Speciality Spotlight

 

 

Incompetent Shirodkar Suture
   

  • (b) Cervical length at 23 weeks of gestation: The value of Shirodkar suture for the short cervix. 
    VCG Heath, AP Souka, I Erasmus (King’s College Hosp Med School, London): 
    Ultrasound Obstet Gynecol; 12 : 318-322, 1998.
        
    In the second article from King’s College Hosp Med School, London, authors conclude that women with a cervical length of 15mm or less at 23 weeks gestation have a more than 50% chance of spontaneous delivery before 32 weeks. Inserting Shirodkar suture in these women may greatly reduce the risk of early delivery. This is a comment from Dr. Thomas H Kirschbaum (Editor).
        
    In these 2 confusing articles, the King’s College Hospital group use a prospective but uncontrolled study to make the case for cerclage in women with reduced cervical length at 22-24 weeks gestation to prevent preterm delivery. They have not identified the controls based on an intent to treat by cerclage, but management rests with individual doctors who likely differ in skill and expertise. Also the decision for surgery is not controlled. Hence another large trial will be required of enrolled patients because even with repeated pregnancy losses, about 3/4th of such women will have spontaneously successful pregnancies without surgical intervention. Editor also comments that funneling of the cervix is of little value in predicting preterm labour.
        

      

 

By |2022-07-20T16:43:03+00:00July 20, 2022|Uncategorized|Comments Off on Incompetent Shirodkar Suture

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