Clinical evaluation of 554 cases of cervical insufficiency

Abstract

Objective To evaluate the effects of diagnosis of cervical insufficiency and different management on pregnancy outcomes. Methods From June 2004 to May 2010, a retrospective analysis was carried out on 554 patients with cervical insufficiency in nine hospitals in Guangdong Province, China. The patients were divided into two groups, the cervical cerclage surgical treatment group (surgical group, n=357) and the expectant treatment group (n=197). These patients were then re-diagnosed according to the unified diagnostic criteria by the American College of Obstetricians and Gynecologists (2014), and divided into the definite diagnosis group (n=425) and the indefinite diagnosis group (n=129). The two independent samples t-test and Chi-square test were used to compare pregnancy outcomes between the definite and indefinite diagnosis groups, and the different treatment groups. Results The full-term delivery rate in the surgical group was significantly higher than that in the expectant treatment group [40.3% (144/357) vs 23.4% (46/197), χ2=16.254, P=0.000], and the late abortion rate was lower in the surgical group than in the expectant treatment group [22.4% (80/357) vs 40.1% (79/197), χ2=19.419, P=0.000]. In women with a definite diagnosis of cervical insufficiency, full-term delivery rate [44.7% (117/262) vs 20.9% (34/163), χ2=24.844, P=0.000], and newborn body weight were significantly higher in the surgical group [(2 664.3±762.2) vs (2 416.9±845.0) g, t=1.160, P=0.014] than in the expectant treatment group and the late abortion rate was significantly lower [21.4% (56/262) vs 41.1% (67/163), χ2=19.021, P=0.000]. Cervical cerclage in the indefinite diagnosis group did not resulted in raising the full-term delivery rate [28.4% (27/95) vs 35.3% (12/34), χ2=0.561], preterm delivery rate [46.3% (44/95) vs 29.4% (10/34), χ2=2.940], late abortion rate [25.3% (24/95) vs 35.3% (12/34), χ2=1.252] and newborn body weight [(2 526.5±761.8) vs (2 683.4±725.8) g, t=0.004] compared with expectant treatment group (all P>0.05). Pregnancy outcomes in the surgical treatment group in relation to twin pregnancies were not significantly different in the ≥28 weeks delivery rate [81.4% (37/46) vs 69.2% (18/26), χ2=1.156], late abortion rate [19.6% (9/46) vs 30.8% (8/26), χ2=1.156] and newborn birth weight [(2 003.2±621.0) vs (1 807.5±609.4) g,t=0.057] compared with those in the expectant treatment group (all P>0.05). Conclusions In accordance with the diagnostic criteria for cervical insufficiency and indications for cervical cerclage in surgical cases, cervical cerclage can effectively improve pregnancy outcome. But cervical cerclage is not recommended in twin pregnancies with cervical insufficiency. Key words: Uterine cervical incompetence; Cerclage, cervical; Treatment outcome; Pregnancy outcome