Ultrasound-predicated versus history-predicated cerclage in XXXX at risk of @entity1887 : a systematic review.

@entity1 @entity3152 @entity1887 @entity3799 @entity393
The aim of this systematic review was to compare pregnancy outcomes and cerclage-related complications of ultrasound-predicated versus history-predicated cerclage in @entity1 at risk of @entity1887 due to a history of @entity3152 ( @entity3152 ). A structured search was performed in PubMed, Embase, and the Cochrane Library to identify potentially relevant articles from January 1980 through July 2007. Studies were included if ultrasound-predicated cerclage was compared to history-predicated cerclage in @entity1 with a singleton gestation and a history of @entity3152 . The PubMed, Embase, and Cochrane search yielded 537, 643, and 42 articles, respectively. In addition, 1194 "Related articles" (PubMed) and 87 "Cited in/cited by" (ISI-WOS) from all potentially relevant articles were assessed. After critical evaluation for relevance and quality, 6 articles remained. Five of the 6 included studies showed no differences in pregnancy outcome ( @entity3152 or @entity393 <24 weeks) between the ultrasound-predicated and the history-predicated cerclage groups. In 1 prospective cohort study, @entity3152 below 30 weeks was significantly lower in the ultrasound group. The included studies showed that in the ultrasound group, 40% to 68% of the @entity1 did not require cerclage. The majority of studies provided insufficient data to draw conclusions regarding cerclage-related complications. In conclusion, using ultrasound to identify @entity1 at risk of @entity1887 because of a history of @entity3152 reduces cerclage rates and results in similar pregnancy outcomes as cerclage placement on the basis of history alone. TARGET AUDIENCE: Obstetricians _ Gynecologists, Family Physicians. LEARNING OBJECTIVES: After reading this article, the reader should be able to identify his or her own management of @entity1 with prior history of @entity3152 with respect to the possible use of cerclage, design a diagnostic strategy for his or her own @entity1 to determine whether history or ultrasound-based decision making is appropriate in the practice setting, and translate best-practices with respect to @entity3799 in his or her own practice.
