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The power of meta-analysis to address an important clinical question in obstetrics

Published:January 28, 2017DOI:https://doi.org/10.1016/j.ajog.2017.01.028
      After 17 years of collaborative research, a meta-analysis of randomized controlled trials on cerclage for singleton gestations with a prior spontaneous preterm birth and with a short transvaginal ultrasound cervical length <25mm before 24 weeks led to new clinical recommendations worldwide. This is an example of the power of meta-analyses, of why I like them, and why I think you should like them too. Many societies rank meta-analyses of randomized controlled trials as the best level of evidence, even above that of a single randomized controlled trial.

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      References

        • Berghella V.
        • Odibo A.O.
        • To M.S.
        • Rust O.A.
        • Althuisius S.M.
        Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data.
        Obstet Gynecol. 2005; 106: 181-189
        • Berghella V.
        • Kuhlman K.
        • Weiner S.
        • Teixera L.
        • Wapner R.
        Cervical funneling: sonographic criteria predictive of preterm delivery.
        Ultrasound Obstet Gynecol. 1997; 10: 161-166
        • Berghella V.
        • Kuhlman K.
        • Weiner S.
        • Teixera L.
        • Wapner R.
        Cervical funneling: sonographic criteria predictive of preterm delivery.
        Ultrasound Obstet Gynecol. 1997; 10: 161-166
        • Iams J.D.
        • Goldenberg R.L.
        • Meis P.J.
        • et al.
        The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network.
        N Engl J Med. 1996; 334: 567-572
      1. Berghella V, Tolosa J, Kuhlman K, Weiner S, Bolognese R, Wapner R. Cervical sonography compared to manual examination as a predictor of preterm delivery. Oral presentation at: Annual Meeting of the Society of Perinatal Obstetricians, January 23rd, 1997; Anaheim, CA. Am J Obstet Gynecol 1997;176(2 - Supplement), S7.

        • Berghella V.
        • Tolosa J.E.
        • Kuhlman K.A.
        • Weiner S.
        • Bolognese R.
        • Wapner R.
        Cervical ultrasonography compared to manual examination as a predictor of preterm delivery.
        Am J Obstet Gynecol. 1997; 177: 723-730
      2. Berghella V, Daly S, Tolosa JE, DiVito M, Wapner R. Does salvage cerclage prevent preterm delivery in patients with sonographic cervical shortening and/or funneling? Oral presentation at: Annual Meeting of the Society for Maternal-Fetal Medicine, January 22, 1999; San Francisco, CA. Am J Obstet Gynecol 1999;180(2 - Supplement), S23.

        • Berghella V.
        • Daly S.F.
        • Tolosa J.E.
        • et al.
        Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity?.
        Am J Obstet Gynecol. 1999; 181: 809-815
        • Berghella V.
        • Odibo A.O.
        • Tolosa J.E.
        Cerclage for prevention of preterm birth in women with a short cervix on transvaginal ultrasound: a randomized trial.
        Am J Obstet Gynecol. 2004; 191: 1311-1317
        • Rust O.A.
        • Atlas R.O.
        • Reed J.
        • van Gaalen J.
        • Balducci J.
        Revisiting the short cervix detected by transvaginal ultrasound in the second trimester: why cerclage therapy may not help.
        Am J Obstet Gynecol. 2001; 185: 1098-1105
        • Althuisius S.M.
        • Dekker G.A.
        • Hummel P.
        • Bekedam D.J.
        • van Geijn H.P.
        Final results of the Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone.
        Am J Obstet Gynecol. 2001; 185: 1106-1112
        • To M.S.
        • Alfirevic Z.
        • Heath V.C.
        • Fetal Medicine Foundation Second Trimester Screening Group
        Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial.
        Lancet. 2004; 363: 1849-1853
        • Owen J.
        • Hankins G.
        • Iams J.D.
        • et al.
        Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length.
        Am J Obstet Gynecol. 2009; 201: 375.e1-375.e8
        • Berghella V.
        • Rafael T.J.
        • Szychowski J.M.
        • Rust O.A.
        • Owen J.
        Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis.
        Obstet Gynecol. 2011; 117: 663-671
      3. Cervical cerclage. Green-top guideline no. 60. Royal College of Obstetricians and Gynecologists. Available at: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg60/. Accessed March 1, 2017.

        • Society for Maternal-Fetal Medicine Publications Committee, with assistance of Vincenzo Berghella
        Progesterone and preterm birth prevention: translating clinical trials data into clinical practice [erratum in: Am J Obstet Gynecol 2013;208:86].
        Am J Obstet Gynecol. 2012; 206: 376-386
        • American College of Obstetricians and Gynecologists
        Prediction and prevention of preterm birth. ACOG Practice bulletin no. 130.
        Obstet Gynecol. 2012; 120: 964-973
        • Brown R.
        • Gagnon R.
        • Delisle M.F.
        • et al.
        • Maternal Fetal Medicine Committee
        Cervical insufficiency and cervical cerclage.
        J Obstet Gynaecol Can. 2013; 35: 1115-1127
        • Villar J.
        • Carroli G.
        • Belizán J.M.
        Predictive ability of meta-analyses of randomized controlled trials.
        Lancet. 1995; 345: 772-776
        • LeLorier J.
        • Grégoire G.
        • Benhaddad A.
        • Lapierre J.
        • Derderian F.
        Discrepancies between meta-analyses and subsequent large randomized, controlled trials.
        N Engl J Med. 1997; 337: 536-542
        • Berlin J.A.
        • Golub R.M.
        Meta-analysis as evidence. Building a better pyramid.
        JAMA. 2014; 312: 603-605
      4. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement. EQUATOR. Available at: http://www.equator-network.org/reporting-guidelines/prisma/. Accessed Jan. 9, 2017.