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Tocolytics used as adjunctive therapy at the time of cerclage placement: a systematic review

Journal of Perinatology volume 35, pages 561–565 (2015)Cite this article

Subjects

Abstract

Objective:

To review the published literature on whether the use of empiric perioperative tocolytic medications could provide additional benefit when used in combination with cerclage.

Study Design:

Systematic review of published medical literature reporting the efficacy of empiric tocolytics used as a perioperative adjunct to vaginal cerclage in high-risk patients. A PubMed search without date criteria of various tocolytics and cerclage yielded 42 studies. Review articles were excluded, as were reports of abdominal cerclage, emergent cerclage, or cerclage for the purpose of delayed interval delivery in twin gestations.

Result:

Only five publications on the topic of perioperative tocolytic use at the time of history or ultrasound-indicated vaginal cerclage placement were identified. These included zero clinical trials, three retrospective cohort studies, one case series and one case report. Only one cohort study compared cerclage with indomethacin and cerclage without indomethacin and suggested no difference between the groups. The other two published cohort studies had no referent group who received cerclage without tocolysis. One case series and one case report were also published reporting cerclage with empiric beta-mimetic and progesterone adjunctive therapy.

Conclusion:

There is a paucity of published data on the topic of adjunctive perioperative tocolytics with cerclage. Adequately powered clinical trials on perioperative use of tocolysis with cerclage compared with a standard cerclage placement alone are needed to establish efficacy. Until adequately studied, this practice should be considered investigational.

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Acknowledgements

Financial support: Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA; March of Dimes Grant 22-FY14-470.

Author information

Authors and Affiliations

  1. Wayne State University School of Medicine, Detroit, MI, USA

    J Smith

  2. Division of Genetic and Metabolic Disorders, Children’s Hospital of Michigan, Detroit, MI, USA

    J Smith

  3. Division of Maternal-Fetal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA

    E A DeFranco

  4. Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    E A DeFranco

Authors
  1. J Smith
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Corresponding author

Correspondence to E A DeFranco.

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The authors declare no conflicts of interest

Additional information

Presentation information: this study was presented as an poster presentation at the 81st Annual Meeting of the Central Association of Obstetricians and Gynecologists, 8 to 11 October 2014, Albuquerque, NM, USA.

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Smith, J., DeFranco, E. Tocolytics used as adjunctive therapy at the time of cerclage placement: a systematic review. J Perinatol 35, 561–565 (2015). https://doi.org/10.1038/jp.2015.38

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