Faculty Collaboration Database

Tocolytics used as adjunctive therapy at the time of cerclage placement: a systematic review. J Perinatol 2015 Aug;35(8):561-5

Date

04/24/2015

Pubmed ID

25905689

DOI

10.1038/jp.2015.38

Scopus ID

2-s2.0-84938294000 (requires institutional sign-in at Scopus site)   12 Citations

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.

Author List

Smith J, DeFranco EA

Author

Jessica A. Smith MD Assistant Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Inflammatory Agents, Non-Steroidal
Cerclage, Cervical
Chemotherapy, Adjuvant
Female
Humans
Indomethacin
Pregnancy
Premature Birth
Randomized Controlled Trials as Topic
Tocolytic Agents
Uterine Cervical Incompetence