Cervical cerclage after hysteroscopic metroplasty

Abstract

Purpose: The objective of the study is to evaluate the role of cervical cerclage after hysteroscopic metroplasty.Methods: Forty‐six women, previously treated by hysteroscopic metroplasty for subseptate uteri, were prospectively recruited for this observational study. A total of 34 patients conceived 46 pregnancies. Miscarriages, ectopic pregnancies, and live births rate were 34, 7, 59%, respectively. Elective or ultrasound indicated cervical cerclage was proposed to these latter 27 patients. After discussing an informed consent form patients were asked to choose the elective cerclage or the ultrasound indicated cerclage. Cervical length was checked every 3 weeks, from 12 weeks of gestation. Indications for cervical cerclage were: cervical funneling or shortening <25 mm. In symptomatic patients, or when cerclage was indicated, a cervicovaginal swab was performed, and, if necessary, antibiotic therapy was started. The Shirodkar technique was adopted for cerclage.Results: Eleven of 27 patients underwent cervical cerclage: seven on ultrasound indication, four electively. Mean gestational age at the time of indicated cervical cerclage was 20 ± 2 weeks. Three patients, in the US‐indicated group, had a pathologic cervicovaginal swab. All no cervical cerclage delivered at term (39 ± 2 weeks). Mean gestational age at delivery in patients who underwent indicated cervical cerclage was significantly lower (P < 0.05) than in patients with no sonographic indication (37 ± 2 vs. 39 ± 1 weeks).Conclusions: Ultrasound cervical assessment is a useful tool to select patients for therapeutical cerclage. According to our data cervical cerclage should be performed only in cases of cervical changes diagnosed by transvaginal sonography.