Roles of prophylactic cervical cerclage in pregnancy outcomes after cold knife conization

Abstract

Objective To study the role of prophylactic cervical cerclage in pregnancy outcomes after cold knife conization (CKC). Methods From January 2009 to August 2013, a total of 62 cases of pregnant women who underwent routine gestational examination and delivered in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were selected as research subjects. All the 62 cases of pregnant women received CKC treatment before pregnancy. According to whether the pregnant women received prophylactic cervical cerclage or not after CKC, they were divided into prophylactic cervical cerclage group (n=14) and without prophylactic cervical cerclage group (n=48). The basic clinical data, delivery conditions and perinatal maternal and neonatal complications of both two groups were collected by retrospective method and analyzed by statistical methods. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Results ①There were no statistical differences between two groups in age, gravidity, parity, assisted reproduction, adverse pregnancy history, the duration of CKC treatment to this pregnancy, complication of chronic diseases, uterine fibroids and scarred uterus (P>0.05). ②Among the 62 cases of pregnant women who received CKC treatment before pregnancy, the successful delivery rate was 95.2% (59/62), and the cesarean section delivery rate was 88.1% (52/59), 15.3% (9/59) pregnant women tried vaginal delivery first, and at last the vaginal delivery rate was 11.9% (7/59), the successful vaginal delivery rate was 77.8%(7/9). ③There were no statistical differences between two groups in gestational age of delivery, cesarean section rate, vaginal delivery rate and rate of vaginal delivery trial (P>0.05). The rate of spontaneous abortion during second trimester in prophylactic cervical cerclage group was 21.4% (3/14) which was statistically higher than that in without prophylactic cervical cerclage group (0, 0/48), and the difference was statistically significant (P=0.010). ④There were no statistical differences between two groups in the incidences arrested labor, premature rupture of membrane, abnormal amniotic fluid, premature infants, intra-uterine asphyxia, anomaly of placenta, postpartum hemorrhage, cervical laceration, postnatal infection, small for gestation age infant and low birth weight infant (P>0.05). The incidences of premature infants and preterm premature rupture of the membranes in prophylactic cervical cerclage group were 36.4% (4/11) and 18.2% (2/11), respectively, and they were three times higher than those in without prophylactic cervical cerclage group which were 10.4% and 4.2%, respectively. Conclusions Prophylactic cervical cerclage could not improve the pregnancy outcomes of pregnant women after CKC, and may improve the risk of spontaneous abortion during second trimester instead, and the incidences of premature delivery and preterm premature rupture of the membranes. So as to the woman of childbearing age who has a birth plan, routine prophylactic cervical cerclage may not be recommended after CKC treatment. As the sample size in this study is small, the roles of prophylactic cervical cerclage on pregnancy outcomes in pregnant women after CKC remains to be confirmed by further studies. Key words: Cold knife conization; Cerclage, cervical; Pregnancy outcome