Re: Cervical cerclage for placenta previa ( long)
From: Ronnie Martinez Brignardello (ronniem@entelchile.net)
Sat Feb 26 13:20:07 2000
......IŽd not thougt about this ?
but.....it make me nervous.
,,I think ..a good bed seems to be better.
ronnie
RModugno@aol.com wrote:
> Has anyone used cervical cerclage in the treatment of placenta previa?
> Here's what the Cochrane Database has to say:
>
> Interventions for suspected placenta praevia
>
> Neilson JP
>
> ABSTRACT
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> A substantive amendment to this systematic review was last made on 17 August
> 1999. Cochrane reviews are regularly checked and updated if necessary.
> Background: Because placenta praevia is implanted unusually low in the
> uterus, it may cause major, and/or repeated, antepartum haemorrhage. The
> traditional policy of care of women with symptomatic placenta praevia
> includes prolonged stay in hospital and delivery by caesarean section.
>
> Objectives: To assess the impact of any clinical intervention applied
> specifically because of a perceived likelihood that a pregnant woman might
> have placenta praevia.
>
> Search strategy: A comprehensive electronic search was performed to identify
> relevant literature. Searched databases included the Trials Register
> maintained by the Cochrane Pregnancy and Childbirth Group, and the Cochrane
> Controlled Clinical Trials Register.
>
> Selection criteria: Any controlled clinical trial that has assessed the
> impact of an intervention in women diagnosed as having, or being likely to
> have, placenta praevia.
>
> Data collection and analysis: Data were extracted from the three identified
> trial reports, unblinded, by the author without consideration of results.
>
> Main results: Two comparisons could be made - home versus hospitalisation and
> cervical cerclage versus no cerclage. Both were associated with reduced
> lengths of stay in hospital antenatally. Otherwise, there was little evidence
> of any clear advantage or disadvantage to a policy of home versus hospital
> care. Cervical cerclage may reduce the risk of delivery before 34 weeks, or
> the birth of a baby weighing less than 2 kg or having a low 5 minute Apgar
> score. In general, these possible benefits were more evident in the trial of
> lesser methodological quality.
>
> Reviewers' conclusions: There are insufficient data from trials to recommend
> any change in clinical practice. Available data should, however, should
> encourage further work to address the safety of more conservative policies of
> hospitalisation for women with suspected placenta praevia, and the possible
> value of insertion of a cervical suture.
>
> Citation: Neilson JP. Interventions for suspected placenta praevia (Cochrane
> Review). In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software.
>
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> For those of you who are interested in reading other Cochrane abstracts on
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> chilbirth topics, go to:
>
> http://www.update-software.com/ccweb/cochrane/revabstr/g010index.htm
>
> Robert Modugno MD MBA FACOG
> Marietta, GA
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