Abstract
Background: Cervical cerclage has been used for decades to
decrease rates of preterm birth. The Shirodkar and McDonald cerclage are
the two most commonly used cerclage techniques with no current consensus
on the preferred technique. Objective: To compare the efficacy
of the two techniques. Search strategy: Studies were sourced
from six electronic databases and reference lists. Selection
criteria: Studies including women with a singleton pregnancy, requiring
a cervical cerclage, using either the Shirodkar or McDonald technique
that ran comparative analyses between the two techniques. Data
collection and analysis: The primary outcome was preterm birth before
37 weeks, with sub analyses at 28, 32, 34 and 35 weeks. Secondary data
was also collected on neonatal, maternal and obstetric outcomes.Main results: Seventeen papers were included - analysis showed
the Shirodkar group had significantly less chance of preterm birth
before 37 weeks (RR 0.91, 95% CI 0.85-0.98). This finding is reinforced
by statistically significant reduction in rates of preterm birth before
37, 35, 34 and 32 weeks, PPROM (RR 0.87, 95% CI 0.77 – 0.99),
difference in cervical length (mean difference 5.25, 95% CI
4.68–5.83), cerclage to delivery interval (mean difference 10.79, 95%
CI 8.20-13.38), and an increase in birthweight (mean difference 348
grams, 95% CI 291–406) in the Shirodkar group. Conclusion:Shirodkar cerclage leads to a significant reduction in preterm birth and
delivers better maternal and neonatal outcomes when compared to McDonald
cerclage. Funding: No funding was required for this review.Keywords: Cervical, Stitch, Cerclage, McDonald, Shirodkar,
Preterm birth