A Comparative Study of Modified Shirodkar's Cerclage and Mcdonald's Cerclage in Cervical incompetence

Abstract

Background and Objectives: The term ‘cervical incompetence’ is used to describe a disorder in which painless cervical dilatation led to recurrent second trimester pregnancy losses .Structural weakness of cervical tissue was thought to cause or contribute to these adverse outcomes. The diagnosis has also been applied to women with one or two such losses/deliveries or at risk for such a loss/delivery. The aims and objectives of this study were to study the maximum gestational age upto which pregnancy can reach after cerclage, the morbidity of the procedure in terms of complications of the surgery, days of hospital stay, cost effectiveness, etc. and to estimate if cerclage prevents preterm birth and perinatal mortality and morbidity in women with previous preterm birth and short cervical length. Methods: A hospital based prospective study including 50 cases of Modified Shirodkar’s Cerclage and 50 cases of McDonald’s Cerclage, from July 2012 to September 2014 at Dr. D.Y. Patil Medical College and Hospital, Pimpri. Results: The average gestational age up to which pregnancy continued in patients with Modified Shirodkar’s Cerclage was 36 weeks compared to patients with McDonald’s Cerclage which was 33 weeks. Conclusion: Modified Shirodkar’s Cerclage was found to be a comparatively better method of cerclage than McDonald’s Cerclage in terms of preventing preterm birth. Women undergoing Modified Shirodkar’s Cerclage carried their pregnancy significantly longer, had lower neonatal admission rates and suffered a lower cost for maternal and neonatal care. They also showed higher birth weights and lower neonatal death rates. Key Words: Cervical Incompetence, Modified Shirodkar’s Cerclage, McDonald’s Cerclage