{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T00:27:28Z","timestamp":1772843248139,"version":"3.50.1"},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T00:00:00Z","timestamp":1745884800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Transvaginal cerclage is an important intervention used to decrease the risk of preterm delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>We performed a systematic review and meta\u2010analysis to evaluate the efficacy of a reinforcing cerclage (<jats:styled-content style=\"fixed-case\">RC<\/jats:styled-content>) should the initial cerclage fail.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search Strategy<\/jats:title><jats:p>Scopus, PubMed, Cochrane Central Register of Controlled Trials, Ovid Medline, CINAHL and <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\">clinicaltrials.gov<\/jats:ext-link> were searched from database inception through December 2023.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection Criteria<\/jats:title><jats:p>All studies compare the use of RC to expectant management after initial cerclage placement to prevent preterm birth.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection and Analysis<\/jats:title><jats:p>Two authors extracted data following PRISMA guidelines. Primary outcomes were gestational age at delivery and preterm delivery rate before 37\u2009weeks. Subgroup analyses examined outcomes by initial cerclage indication (history\u2010indicated, ultrasound\u2010indicated, and physical exam\u2010indicated). Results were summarised as weighted mean difference (MD) or risk ratio (RR) with associated 95% confidence intervals. Heterogeneity was measured using Higgins <jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Results<\/jats:title><jats:p>Eight studies (<jats:italic>n<\/jats:italic>\u2009=\u2009440), comparing RC to no RC after initial cerclage failure, met inclusion criteria. Primary analysis showed delivery occurred 3.98\u2009weeks earlier with RC (95% CI [\u22125.29, \u22122.67], <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001). The RC group had a higher preterm delivery rate before 37\u2009weeks (RR 1.46, 95% CI [1.03, 2.06], <jats:italic>p<\/jats:italic>\u2009=\u20090.03). High heterogeneity (<jats:italic>I<\/jats:italic><jats:sup>2<\/jats:sup>\u2009&gt;\u200980%) was noted, and all included studies were observational, increasing the risk of selection bias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Placement of a <jats:styled-content style=\"fixed-case\">RC<\/jats:styled-content> following failure of an initial cerclage was associated with a reduced pregnancy latency and an increased risk for preterm delivery. Given the non\u2010randomised nature of the available evidence and significant heterogeneity, these findings should be interpreted with caution. Reinforcing cerclage should only be considered within research settings.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.18185","type":"journal-article","created":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T05:44:54Z","timestamp":1745905494000},"page":"1202-1211","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cerclage Reinforcement Following Primary Cerclage Procedure for Prevention of Preterm Birth: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1111","volume":"132","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6390-9743","authenticated-orcid":false,"given":"Neel S.","family":"Iyer","sequence":"first","affiliation":[{"name":"Section of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Olive View\u2010UCLA Medical Center  Sylmar California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virali","family":"Patel","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda","family":"Roman","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Clarfield","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Contag","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics, Gynecology, and Women's Health University of Minnesota  Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rebecca","family":"Menzies","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology University of Toronto  Toronto Ontario USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2854-0239","authenticated-orcid":false,"given":"Vincenzo","family":"Berghella","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine, Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,4,29]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(12)60560\u20101"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1742-4755-10-S1-S2"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)60074-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.28"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.0960-7692.2001.00526.x"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.11.1340"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/GCO.0b013e328359823a"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199602293340904"},{"key":"e_1_2_11_10_1","first-page":"372","article-title":"Practice Bulletin No. 142. 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