Prevalence of colonisation with group B Streptococci in pregnant women of a multi-ethnic population in The Netherlands

OBJECTIVE: This study was performed to determine the prevalence of GBS and to identify GBS colonisation risk factors in a multicultural population of pregnant women in The Netherlands. We calculated predictive values of cultures in pregnancy for intrapartum GBS carriage. STUDY DESIGN: From a total of 1702 women visiting several antenatal outpatient departments, rectovaginal swabs were collected at 35-37 weeks' gestation. In 761 women swabs were repeated at time of delivery. Carriage of GBS late in third trimester and at time of delivery was analysed in relation to age, parity, ethnicity and socio-economic status. RESULTS: Twenty-one percent was GBS carrier late in pregnancy. Compared to Europeans, African women were at a higher risk (29%, RR 1.4, CI 1.1-1.7) and Asian women were at lower risk (13%, RR 0.6, CI 0.4-0.8) for GBS carriage. No differences in colonisation were found between women with respect to age, parity or socio-economic background. Positive predictive value of GBS carriage at 35-37 weeks' gestation for carriage at time of parturition was 79% and negative predictive value was 93%. CONCLUSIONS: It was not possible to identify a group of pregnant women at high risk for GBS colonisation. Predictive values of antenatal genital group B streptococci cultures at 35-37 weeks' gestation for intrapartum GBS carriage are lower than previously reported.     

Bacterial vaginosis in a cohort of Danish pregnant women: prevalence and relationship with preterm delivery, low birthweight and perinatal infections

OBJECTIVE: To determine the prevalence of bacterial vaginosis (BV) in the second trimester of pregnancy in a Danish population using the Schmidt criteria and to examine whether BV was associated with subsequent preterm delivery, low birthweight or perinatal infections. DESIGN: Prospective cohort study. SETTING: Department of Obstetrics and Gynaecology at a University Hospital, Denmark. POPULATION: Three thousand five hundred and forty pregnant women aged 18 years or more. METHODS: A smear from the vagina was obtained from all women, air-dried and stored for subsequent diagnosis of BV. After rehydration with isotonic saline, the smear was examined in a phase-contrast microscope at 400x, and the numbers of lactobacilli morphotypes and small bacterial morphotypes were counted. A score for BV was calculated according to the method described by Schmidt. The outcome of pregnancy from 20 weeks of gestation was examined in the 3262 singleton pregnant women who were included in this study before 20 weeks of gestation. The relationship between BV and adverse outcome of pregnancy was examined by univariate and multivariate analyses. MAIN OUTCOME MEASURES: Prevalence of BV, preterm delivery (<37 weeks), low birthweight (<2500 g), preterm delivery of a low-birthweight infant and clinical chorioamnionitis. RESULTS: The prevalence of BV was 16%, and the rate of preterm delivery was 5.2% in the study population of 3262 singleton pregnant women who were included before 20 weeks of gestation. Mean birthweight was significantly lower in infants of women with BV than in infants of women without BV (3408 versus 3511 g, P < 0.01). Univariate analyses showed that BV was marginally associated with preterm delivery but significantly associated with low birthweight, preterm delivery of a low birthweight infant, indicated preterm delivery and clinical chorioamnionitis. Multivariate analyses, which adjusted for previous miscarriage, previous preterm delivery, previous conisation, smoking, gestational diabetes, fetal death and preterm premature rupture of membranes, showed that BV was significantly associated with low birthweight (OR 1.95, 95% CI 1.3-2.9), preterm delivery of a low-birthweight infant (OR 2.5, 95% CI 1.6-3.9), indicated preterm delivery (OR 2.4, 95% CI 1.4-4.1) and clinical chorioamnionitis (OR 2.7, 95% CI 1.4-5.1). CONCLUSIONS: The prevalence of BV determined using the Schmidt criteria in the early second trimester of pregnancy was similar to that found in similar studies. The presence of BV before 20 weeks of gestation was an independent risk factor for delivery of an infant with low birthweight, preterm delivery of a low-birthweight infant, indicated preterm delivery and clinical chorioamnionitis.     

Group B Streptococcal Colonization and Preterm Labour

Summary: Recent publications have highlighted the controversy regarding the significance of Lancefield Group B Streptococcal (GBS) colonization in pregnancy and preterm delivery. In this prospective study vaginal swabs from 692 women at approximately 24 weeks' gestation were cultured for GBS. GBS was detected in 91 (13.2%) women. The rate of preterm labour (PTL) (<37 weeks) was significantly higher in GBS positive women than in GBS negative women (18.7% versus 5.5%; p< 0.001). This association remained significant even when patients with other recognized factors predisposing to PTL were excluded (11.5% versus 3.9%; p< 0.001). The rate of premature rupture of membranes (PROM) was also significantly higher in GBS positive women (9.9% versus 2.7%; p < 0.005) and remained significantly higher when patients with other recognized risk factors were excluded (6.1% versus 1.8%; p < 0.025). These results unequivocably show that pregnant women who are vaginal carriers of GBS have a significantly increased risk of PROM and PTL.     

Association between colonization with group B streptococci during pregnancy and preterm delivery among Danish women

OBJECTIVE: We studied the relationship between group B streptococcal colonization and preterm delivery. STUDY DESIGN: In this prospective study at a single hospital in Odense, Denmark, cervicovaginal cultures were obtained at < or = 24 weeks' gestation from all the women, at delivery from women with preterm deliveries, and from a random sample of women delivering at term. RESULTS: In 2846 singleton births, there was no significant association between group B streptococcal colonization at 相似文献   

Asymptomatic bacterial vaginosis and intermediate flora as risk factors for adverse pregnancy outcome

We updated a previously published meta-analysis to evaluate bacterial vaginosis (BV) and intermediate vaginal flora as risk factors for adverse pregnancy outcome. Selection criteria were original, published, English-language reports of cohort studies or control groups of clinical trials including women <37 weeks' gestation with intact amniotic membranes. All women had to be screened for BV, diagnosed either by clinical criteria or by criteria based on Gram-stain findings. Outcomes were preterm delivery, late miscarriages, maternal or neonatal infections, and perinatal mortality. Fourteen new studies with results for 10,286 patients were included, so that results for 30,518 patients in 32 studies were available for this meta-analysis. BV more than doubled the risk of preterm delivery in asymptomatic patients (OR: 2.16, 95% CI: 1.56-3.00) and in patients with symptoms of preterm labor (OR: 2.38, 95% CI: 1.02-5.58). BV also significantly increased the risk of late miscarriages (OR: 6.32, 95% CI: 3.65-10.94) and maternal infection (OR: 2.53, 95% CI 1.26-5.08) in asymptomatic patients. No significant results were calculated for the outcomes of neonatal infection or perinatal mortality. Also, intermediate vaginal flora was not significantly associated with any outcome included. The results of this meta-analysis confirm that BV is a risk factor for preterm delivery and maternal infectious morbidity and a strong risk factor for late miscarriage.     

Transvaginal ultrasonography of the uterine cervix in hospitalized women with preterm labor.

OBJECTIVE: The aim of this study was to examine the relation between cervical length and the presence of funneling and the risk of preterm delivery. METHOD: This prospective blind cohort involved 200 hospitalized women with preterm labor in a tertiary care hospital. Women were recruited for a single transvaginal ultrasonography to assess cervical length and presence of funneling. The main outcome measures were: (1) relative risks (RR) and adjusted odds ratios of preterm delivery (<37 weeks' gestation); (2) time interval between the cervical ultrasonography date to 37 weeks' gestation or to-preterm birth. RESULTS: The RR of preterm delivery according to the cervical length (cut-off of <30 mm) was 2.79 (95% CI 1.70--4.59). The RR according to the presence of funneling (cut-off of >5 mm) was 1.39 (95% CI 0.99--1.95). The adjusted odds ratio was 3.92 (95% IC 1.75--8.75) for cervical length and 0.77 (95% CI 0.35--1.67) for funneling. Women with a cervical length of <30 mm had a significantly shorter interval from ultrasonography date up to 37 weeks' gestation than did women with a cervical length of >30 mm (P<0.003). CONCLUSION: Ultrasonographic mensuration of the cervix provides predictive information on the risk of preterm delivery.     

Recurrence of preterm birth in singleton and twin pregnancies

OBJECTIVE: To assess recurrence of preterm birth and its impact on an obstetric population. METHODS: Women with consecutive births at our hospital beginning with their first pregnancy were identified (n = 15,945). The first pregnancy was categorized as delivered between 24 and 34 weeks' gestation or 35 weeks or beyond, singleton or twin, and spontaneous or induced. The risk of preterm delivery in these same women during subsequent pregnancies was then analyzed. RESULTS: Compared with women who delivered a singleton at or beyond 35 weeks' gestation in their first pregnancy, those who delivered a singleton before 35 weeks were at a significant increased risk for recurrence (odds ratio [OR] 5.6, 95% confidence interval [CI] 4.5, 7.0), whereas those who delivered twins were not (OR 1.9, 95% CI 0.46, 8.14). The OR for recurrent spontaneous preterm birth presenting with intact membranes was 7.9 (95% CI 5.6, 11.3) compared with 5.5 (95% CI 3.2, 9.4) with ruptured membranes. Of those women with a recurrent preterm birth, 49% delivered within 1 week of the gestational age of their first delivery and 70% delivered within 2 weeks. Among 15,863 nulliparous women with singleton births at their first delivery, a history of preterm birth in that pregnancy could predict only 10% of the preterm births that ultimately occurred in the entire obstetric population. CONCLUSION: In a population-based study at our hospital, women who initially delivered preterm and thus were identified to be at risk for recurrence ultimately accounted for only 10% of the prematurity problem in the cohort.     

Bacterial vaginosis and cervical dilation and effacement at 24-29 weeks' gestation

The purpose of this study was to investigate the association between bacterial vaginosis (BV) and cervical dilation and effacement, as measures of impending preterm delivery. The Pregnancy, Infection, and Nutrition Study collected genital tract specimens and documented cervical change from 807 eligible women between 24 and 29 weeks' gestation. BV was assessed with Nugent-scored vaginal smears, and analyzed in relation to cervical measurements. At 24-29 weeks' gestation, <7% of women had a dilated cervix, 31% had a cervix < or =2 cm, and 17.3% had BV. Unadjusted analyses found no associations between BV and cervical measurements. Adjusted logistic regression suggested an association between BV and cervical effacement among women with a sexually transmitted disease (STD) earlier in pregnancy (odds ratio = 1.9, 95% CI 0.8-4.3). Stratified analyses for BV/dilation also suggested interaction with STDs. Overall, BV was not association with cervical dilation or effacement at 24-29 weeks' gestation.     

The interaction effect of bacterial vaginosis and periodontal disease on the risk of preterm delivery

The objective of this article is to determine if coexistence of periodontal disease (PD) and bacterial vaginosis (BV) is synergistic on the risk of spontaneous preterm delivery (sPTD). The study design was secondary analysis of a prospective cohort study. Women were screened 6 to 20 weeks gestation for PD and BV. Groups were defined by presence of BV and stratified on PD. The primary outcome was sPTD <37 weeks gestation. Univariable, stratified, and multivariable analyses were performed to estimate the main and interaction effects of BV and PD on sPTD. Of 1453 women screened, 792 (54.5%) were diagnosed with BV. Neither women with BV in the first trimester nor PD was at higher risk of sPTD (risk ratio [RR] for BV 1.1; 95% confidence interval (CI), 0.8-1.5, and RR for PD 0.9; 95% CI, 0.7-1.3). The interaction between BV and PD did not statistically significantly impact the odds of sPTD. Coexistence of PD and BV did not have a synergistic effect on sPTD.     

Cervical dimensions and risk of preterm birth: a prospective cohort study

OBJECTIVE: To examine the relation between cervical dilatation and length and the risk of spontaneous preterm birth, including its subtypes preterm labor and preterm premature rupture of membranes (PROM). METHODS: Cervical dimensions assessed by clinical examination were recorded prospectively at 24-29 weeks' gestation in 871 subjects with singleton pregnancies who were followed to delivery. Relative risks (RRs) of preterm birth, preterm labor, and preterm PROM were calculated for clinically distinguishable categories of cervical dilatation and length and for cervical score (length minus dilatation). Regression analysis was used to adjust for confounding. Time to delivery from baseline examination was summarized using survival analysis. RESULTS: There were 73 spontaneous preterm births (8.3%), 46 preterm labors and 27 cases of preterm PROM. All cervical measurements were associated with increased risks of preterm birth, with increasing abnormality more strongly predictive of risk. The adjusted RR for preterm birth with dilatation of at least 0.5 cm was 2.9 (95% confidence interval [CI] 1.2, 7.3); for length of 1.5 cm or less, the RR was 2.1 (95% CI 1.0, 4.5), and for cervical score less than 2.0, the RR was 2.8 (95% CI 1.4, 5.6). The association with cervical measurements was stronger for preterm PROM than for preterm labor, although precision was limited. These measurements had high specificity (93-99%) and low sensitivity (8-20%) for predicting preterm birth. CONCLUSION: In asymptomatic women at 24-29 weeks' gestation, greater cervical dilatation and shorter length were associated with increased risk of spontaneous preterm delivery, particularly preterm PROM.     

Association between maternal serum alpha-fetoprotein and adverse outcomes in pregnancies with placenta previa

OBJECTIVE: To determine whether increased maternal serum alpha-fetoprotein (MSAFP) level at 15-20 weeks' gestation is a marker of adverse outcomes in women with placenta previa at delivery. METHODS: We conducted a retrospective cohort study of singleton pregnancies complicated by placenta previa, diagnosed sonographically, and confirmed at delivery. All women had MSAFP screening at 15-20 weeks' gestation and delivered nonanomalous live-born infants at or after 24 weeks' gestation. RESULTS: One hundred seven women with placenta previa delivered during the study. Fourteen (13%, 95% CI 7%, 21%) had MSAFP at least 2.0 multiples of the median (MoM). They were significantly more likely than those with lower MSAFP levels to have one or more of the following outcomes: hospitalization for antepartum bleeding before 30 weeks' gestation (50% versus 15%), delivery before 30 weeks' gestation (29% versus 5%), or preterm delivery for pregnancy-associated hypertension before 34 weeks' gestation (14% versus none). The MSAFP cutoff of 2.0 MoM provided the best combination of sensitivity and specificity for those outcomes, using receiver operating characteristic curves. CONCLUSION: Women with placenta previa who also have high MSAFP levels are at increased risk of bleeding in the early third trimester and preterm birth. We did not find women who required cesarean hysterectomy, including those with placenta accreta, to consistently have elevated MSAFP.     

Second trimester folate status and preterm birth

OBJECTIVE: The purpose of this study was to show that maternal folate status during pregnancy may be related to preterm birth. STUDY DESIGN: Women were recruited at 24 to 29 weeks' gestation from 1995 to 2000 into the Pregnancy, Infection, and Nutrition Study. Those who completed an interview and a food frequency questionnaire, or provided a blood sample for radioassay of serum (n = 2026) and red blood cell (n = 1034) folate were included. RESULTS: Mean daily dietary folate intake was 463 microg (SD +/- 248). Intake 相似文献   

Prepregnancy body mass index and pregnancy weight gain: associations with preterm delivery. The NMIHS Collaborative Study Group

OBJECTIVE: To examine associations between rate of pregnancy weight gain and preterm delivery among women of varying prepregnancy body mass indices (BMI). METHODS: Subjects were 3511 mother-infant pairs from the 1988 National Maternal and Infant Health Survey. Prenatal weight measured between 14 and 28 weeks' gestation was used to calculate rate of pregnancy weight gain for each woman. Weight gain (lb/week) was categorized as low (under 0.5), average (0.5-1.5), or high (above 1.5). Prepregnancy BMI was calculated as weight divided by height in (kg/m(2)) and categorized as low (under 19.8), average (19.8-26.0), and high (above 26). Delivery before 37 weeks' gestation was considered preterm. Associations between BMI, weight gain, and preterm delivery were examined before and after exclusion of medically indicated preterm deliveries and pregnancies complicated by maternal medical conditions potentially related to weight gain or fetal growth restriction. Associations were expressed as odds ratios (OR) adjusted for several potential confounding factors. RESULTS: Women with low pregnancy weight gain were at increased risk of preterm delivery. The magnitude of risk varied according to a woman's prepregnancy BMI. After all exclusions and adjustments for confounders, ORs, and 95% confidence intervals (CI) for low pregnancy weight gain were 6.7 (1.1, 40.6) for underweight women, 3.6 (1.6, 8.0) for average-weight women, and 1.6 (0.7, 3.5) for overweight women compared with average-weight women with average pregnancy weight gain. CONCLUSIONS: Low weight gain in pregnancy was associated with increased risk of preterm delivery, particularly if women were underweight or of average weight before pregnancy.     

Evaluation of specific symptoms of bacterial vaginosis among pregnant women

Objective: Identification of the symptoms of bacterial vaginosis (BV) in pregnancy might be rational in order to identify a possible BV-associated group at risk of preterm delivery.Methods: Three hundred and five women early in the third trimester of pregnancy were interviewed about lifestyle factors and specific symptoms of BV and given a vaginal examination. A longitudinal three-week follow-up was conducted for 127 women.Results: The prevalence of BV was 16%. Women with BV were significantly more often smokers than women without BV (52% vs. 34%). No difference in sexual activity or other behavioral characteristics between the two groups were seen. No differences were noted among women with and without BV according to specific symptoms: malodorous discharge (26% vs. 23%), increased discharge (76% vs. 68%), or itching or troublesome discharge. More than one third of women with BV at the first examination did not fulfill the criteria for BV at the three week follow-up exam. None of the women without BV had developed BV by the follow-up exam. The incidence of preterm delivery among women with BV was 4%, women without BV had an incidence of 2.4%. This difference was not statistically significant.Conclusion: Asymptomatic BV in pregnancy is common. Specific questions about the character of the discharge do not identify women with BV during pregnancy. To identify a potential BV-associated group at risk for preterm delivery, screening for BV must be conducted not only among symptomatic women but among all women. Women with BV are more often smokers than women without BV.     

Medically recommended cessation of employment among pregnant women in Georgia

OBJECTIVE: To ascertain the proportion of employed pregnant women who receive medical advice to stop working during pregnancy and to describe their characteristics. METHODS: Data were analyzed from the Georgia Pregnancy Risk Assessment Monitoring System, a surveillance system that surveys new mothers about pregnancy risk factors, health behaviors, and birth-related outcomes. Employment during pregnancy was defined as work for pay for 10 hours or more per week. RESULTS: We studied 1635 women who were employed during pregnancy. A physician or nurse had advised 27.7% (95% CI 24.5%, 30.9%) of them to stop working during pregnancy. Independent predictors of receiving this advice were hospitalization (RR 2.3, 95% CI 1.7, 2.8) and history of previous preterm birth (RR 1.6, 95% CI 1.1, 2.2). Low birth weight (under 2500 g) occurred in 5.8% of women not advised to stop work, in 6.9% of women advised to stop work because of swelling, fatigue, stress, or another reason, and in 13.4% of women advised to stop work because of labor, high blood pressure, or vaginal bleeding (P <.001). Among women advised to stop working in the first through seventh months of pregnancy, 91.7% (95% CI 88.8, 94.5) delivered at 36 or more weeks' gestation. CONCLUSION: Work cessation during pregnancy was commonly recommended in this population and was associated with clinical risk factors and adverse birth outcomes. For some women it resulted in a long period of work absence before delivery.     

Second-trimester maternal serum alpha-fetoprotein and risk of adverse pregnancy outcome(1)

OBJECTIVE: To determine the risk of adverse pregnancy outcome by maternal serum alpha-fetoprotein (MSAFP) level. METHODS: We followed 77,149 pregnant women and their infants from MSAFP screening in the 15th to 20th week of gestation until 1 year after birth. Information on pregnancy outcome was obtained from national registries. The relative risks (RRs) and 95% confidence intervals (CIs) for adverse pregnancy outcome were estimated according to the level of MSAFP, with adjustment for confounders. RESULTS: A total of 638 pregnancies resulted in spontaneous abortion, 289 in stillbirth, and 437 in infant death. Compared with women with MSAFP levels at 0.75-1.24 multiples of the median (MoM), those with MSAFP levels greater than or equal to 2.5 MoM had an increased risk of spontaneous abortion (RR 12.5; 95% CI 9.7, 16.1), preterm birth (RR 4.8; 95% CI 4.1, 5.5), small for gestational age (RR 2.8; 95% CI 2.4, 3.2), low birth weight (RR 5.8; 95% CI 5.0, 6.6), and infant death (RR 1.9; 95% CI 1.2, 2.8). Women with MSAFP levels below 0.25 MoM had an increased risk of spontaneous abortion (RR 15.1; 95% CI 9.3, 24.8), preterm birth (RR 2.2; 95% CI 1.3, 3.8), and stillbirth (RR 4.0; 95% CI 1.0, 16.0); those with levels less than 0.5 MoM had an increased risk of infant death (RR 1.9; 95% CI 1.2, 3.0). The increased risk of infant death remained after the subtraction of recognized conditions associated with extreme MSAFP values. CONCLUSION: Pregnant women with extreme MSAFP values in the second trimester have an increased risk of fetal and infant deaths. Obstet Gynecol 2001;97:277-82.     

Bacterial vaginosis in early pregnancy and pregnancy outcome.

OBJECTIVE: We assessed the association between bacterial vaginosis in early pregnancy and adverse pregnancy outcome. METHODS: Vaginal swabs for bacterial culture, Gram stain, and Papanicolaou stain were taken at the first prenatal visit between 8-17 weeks' gestation in 790 healthy nulliparous women. RESULTS: Culture-proven bacterial vaginosis was detected in 169 of 790 women (21.4%), 167 (98.8%) of whom could also be identified by Gram stain. Papanicolaou smears were available from 299 women, among whom 101 had bacterial vaginosis on culture; of these 101, 78 (77.2%) could be detected by Papanicolaou stain. Of the 751 women whose clinical follow-up was completed, 42 had been treated for preterm uterine contractions (preterm labor), but only 17 delivered between 20-36 weeks' gestation (preterm birth). Premature rupture of membranes (PROM) occurred more than 6 hours before delivery in 80 cases (nine preterm and 71 term). Bacterial vaginosis in early pregnancy predicted preterm labor, preterm birth, or preterm PROM with a sensitivity of 41-67%, specificity of 79%, and negative predictive value of 96-99%, but the positive predictive value was low at 4-11%. However, bacterial vaginosis was associated with a 2.6-fold risk (95% confidence interval [CI] 1.3-4.9) for preterm labor, a 6.9-fold risk (95% CI 2.5-18.8) for preterm birth, and a 7.3-fold risk (95% CI 1.8-29.4) for preterm PROM. CONCLUSIONS: Bacterial vaginosis in early pregnancy can be detected reliably by Gram stain and, in most cases, by Papanicolaou smear. Although bacterial vaginosis is associated with preterm labor, preterm birth, and preterm PROM, the clinical usefulness of its assessment is limited because of the high rate of false-positive findings.     

Pregnancy outcome after early detection of bacterial vaginosis

OBJECTIVE: To assess if detecting bacterial vaginosis either in early pregnancy or at midtrimester may predict adverse pregnancy outcome in women at risk for preterm delivery. STUDY DESIGN: 242 pregnant women with a previous preterm delivery were evaluated for bacterial vaginosis either in the first trimester (prior to 10+0 weeks) or in the second one (24-26 weeks). Adverse outcome was intended as miscarriage (< or =25 weeks), or premature delivery (< or =36+6). RESULTS: The risk of adverse pregnancy outcome was significantly increased in women diagnosed at first trimester with bacterial vaginosis (OR: 4.56; 95% CI: 2.54-8.93); the same finding at midtrimester did not increase significantly the risk of preterm delivery. CONCLUSIONS: Early screening for bacterial vaginosis in pregnant women who experienced a preterm delivery may help in predicting the risk of adverse outcome.     

Colonization with group B streptococcus in pregnant women taken into the care of unit K and hospitalized in the department of obstetric pathology]

Colonization with group B streptococci (GBS) in 714 pregnant women was investigated. Among 232 were hospitalised in department of pathological pregnancy and 512 were under ambulatory control. In 13.4% of hospitalised patients and 2.8% healthy pregnant women the colonization of vagina or throat with GBS was stated. The greatest percentage of vagina colonization was found in patients hospitalised in connection with gestosis or because of abortions, premature delivery and inanimate fetus. No correlation was found between range of GBS colonization and trimester of pregnancy. Almost all GBS strains proved to be susceptible for commonly used antibiotics but resistant to biseptol (88.2%). Patients of hospitalised group were more often colonized not only GBS but also other potentially pathogenic microorganisms.     

Novel application of polypropylene sling: transvaginal cervicoisthmic cerclage in women with high risk of preterm delivery

STUDY OBJECTIVE: To describe a novel technique of transvaginal cervicoisthmic cerclage with a polypropylene sling in prevention of preterm labor in pregnant women at high risk. DESIGN: Retrospective study (Canadian Task Force classification: III). SETTING: University hospital (department of obstetrics and gynecology). PATIENTS: Twenty-one women showing symptoms of high risk of preterm delivery: histories of pregnancy losses in the second trimester and prior failure of MacDonald's cerclage or absent portio vaginalis of the cervix. The median age of the patients was 32.8 years (range 22-39 years). INTERVENTIONS: Cerclage was performed between 12 and 16 weeks' gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. Caesarean delivery was systematically performed in all patients because the cerclage was considered to be definitive. MEASUREMENTS AND MAIN RESULTS: No intraoperative complications occurred. The mean operating time was 36 +/- 6 minutes (range 30-45 minutes). The mean length of stay was 1.4 +/- 0.5 days. Mean gestational age and birth weight at delivery were respectively 37.1 +/- 1.8 weeks (CI 95%: 36.4-37.9) and 2850 +/- 745 g (CI 95%: 2531-3168). The preterm birth rate was 19% (4/21). One neonatal death occurred after amniotic fluid infection at 34 weeks. Birth at less than 32 weeks occurred in one patient (4%). CONCLUSION: Transvaginal cervicoisthmic cerclage with polypropylene sling may be considered as an effective and minimally invasive alternative to the transabdominal cervicoisthmic cerclage in women presenting with high risk of preterm delivery.