P32.06: Cervical cerclage for prevention of preterm birth: review of 18 cases

Abstract

Objectives: Preterm birth continues to be the leading cause of neonatal morbility and mortality in industrialized countries. Cervical insufficiency (CI) remains a challenging entity, especially because clear clinical criteria for the diagnosis have not been defined and because there are conflicting results in randomized controlled trials evaluating the use of cervical cerclage. To evaluate the efficacy of cervical cerclage in prolonging pregnancy and preventing preterm birth in women with cervical insufficiency. Study design: retrospective observational study. Methods: The clinical records of 18 women with singleton pregnancies and the diagnosis of CI, submitted to MacDonald’s cerclage between 2000 and 2011 were reviewed. Obstetric management decisions and perinatal results were evaluated. Results: The mean patients’ age was 33 years. 44.4% had ≥3 previous pregnancies. Had a history of abortion, curettage and previous preterm delivery, 83.3%, 38.9% and 33.3%, respectively. 77.8% had a history of late-term abortions; 44.4% early abortions and 33.3% ≥3 previous abortions. 38.9% had a history of cerclage and of these, 42.9% had ≥2. The mean gestational age at surgery was 17 weeks, removing the same, on average, at 32 weeks. 55.6% were submitted to elective cerclage. The mean gestational age at delivery was 33 weeks, with an average time between the removal of cerclage and delivery of 6.4 days. The morbidity included preterm delivery (64.7%), 27.3% of them with preterm premature rupture of membranes. There were two cases of chorioamnionitis (19/24weeks with miscarriage/perinatal death) and 29.4% of admissions in the NICU. Most (61.1%) were born by normal delivery, and the mean birth weight was 2427.6 g. Conclusions: Despite the difficulties in the diagnosis of CI and the lack of evidence demonstrating the effectiveness of cerclage, in selected cases this technique appears to be safe and to achieve good obstetric/neonatal results.