McDonald versus modified Shirodkar rescue cerclage in women with prolapsed fetal membranes

Abstract

Purpose: We compared the efficacy of modified Shirodkar and McDonald rescue cerclage techniques in women with singleton pregnancies.

Methods: The study sample included 47 women who presented at two tertiary hospitals in Turkey from 2008 to 2017 and underwent rescue cerclage due to cervical incompetence and cervical dilatation with fetal membranes prolapsed into the vagina. The outcomes were compared by cerclage technique used, Shirodkar or McDonald.

Results: The McDonald cerclage was applied in 27 cases, and modified Shirodkar cerclage in 20 cases. A longer cerclage-to-birth interval (83.8 ± 37.6 vs. 63.7 ± 38.9 days) and later gestational age at delivery (33 vs. 31 weeks) were observed with the Shirodkar cerclage, although these differences were not statistically significant (p = .08 and .63, respectively). Both groups had similar delivery rates after 28, 32, and 37 weeks (p = .20, .15, and .25, respectively), whereas the modified Shirodkar technique resulted in a higher rate of live births although these differences were not statistically significant (85% vs. 63%, p = .09).

Conclusion: The effects of the McDonald and modified Shirodkar cerclage procedures on prolonging pregnancy and improving the live birth rate were similar. Therefore, either technique can be applied to prevent neonatal loss due to advanced prematurity.

Keywords:

• Cervical incompetence
• McDonald
• premature birth
• rescue cerclage
• Shirodkar

Acknowledgments

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Credits

The authors declare that are qualified for authorship and have participated sufficiently in the work to take public responsibility for appropriate portions of the content. The authors declare that they made a substantial contribution to the concept or design of the work; or acquisition, analysis, or interpretation of data, drafted article or revised it critically for important intellectual content, approved the version to be published, and each author has participated sufficiently in the work and taken public responsibility for appropriate portions of the content.