Insertion Of Cervical Cerclage Research Articles

6301667 Different anaesthetic techniques for cervical cerclage insertion and their influence on patient outcomes

6301667 Different anaesthetic techniques for cervical cerclage insertion and their influence on patient outcomes

Practice of Cervical Cerclage at a University Teaching Hospital in Southern Nigeria

Background: Although the aetiology of preterm deliveries is largely unknown, it is said to be multifactorial and cervical insufficiency has been implicated. Hence, cervical cerclage is a necessary and common prophylactic obstetric procedure for preventing prematurity and associated recurrent second trimester miscarriages. Objectives: To evaluate the pattern, indications, and fetal outcome of cervical cerclage. Methodology: This was a retrospective study of 50 women who had cervical cerclage insertion at the University of Port Harcourt Teaching Hospital between January 1, 2021, and December 31, 2022. Data was obtained from the ward registers, theatre records, and case notes of the women, and entered into a structured proforma. Data analysis was done with SPSS version 25, and results are presented as frequency tables and charts. Results: The mean age of the patients was 35 ± 2.07 years. The mean of number of previous miscarriages was 2.46 ± 2.07, 56.8% were multiparous and 50% had a previous manual vacuum aspiration. Majority 35 (70%) of the women had prophylactic cerclage, 10 (20%) had cerclage following in-vitro fertilization and embryo transfer pregnancy, while 5(10%) had rescue cerclage. Most 29 (58%) of the prophylactic cervical cerclage insertion were done between 11-15 weeks, with MacDonald technique being the most common technique practiced. Of these, only 18 (36%) carried the pregnancy up to 36 weeks of gestation. Conclusion: Many of cervical cerclage procedures were performed for prophylaxis and resulted in improved fetal outcomes in women who had previously experienced mid-trimester losses or preterm delivery.

Cervical Cerclage For Cervical Incompetence: Indication, Complication And Pregnancy Outcome At Aminu Kano Teaching Hospital, Kano: A Five-year Review

Background: Cervical cerclage has salvaged so many pregnancies complicated by cervical incompetence. Objective: This study was carried out to determine the indications and pregnancy outcomes after cervical cerclage insertion. Methodology: This was a five-year retrospective study carried out in the department of Obstetrics and Gynecology of the Aminu Kano Teaching Hospital, Kano. The study covered the period of 1st January 2013 to 31st December 2017. The case notes of women who had cervical cerclage insertion during this period were retrieved and information such as age, gravidity, parity, indication for the cerclage and outcome of the pregnancy were extracted. This was entered into a proforma and analyzed using the SPSS Version 23 Computer software. Results:The mean age of the patients was 31.7±5.3years. Cervical cerclage was inserted between 13 and 32 weeks of gestation with a mean gestational age at insertion of 15.6 ± 3.6weeks. Mc Donald procedure accounted for 98.6% and only 1.4% had Shirodkar procedure. Cervical cerclage was history indicated in 62(87.3%), emergency cerclage was 8(11.3%) and ultrasound indicated in 1 (1.4%) of the women. Following the procedure, 64(80.28%) of the women took the pregnancy to term, however, Equal numbers of pregnancies were complicated by both preterm delivery and miscarriage, 7 (9.85%). Only seven patients had complication and out of that 4(57.1%) had pelvic pain, 2(28.6) had liquor drainage and 1(14.3%) had vaginal bleeding. Conclusion:Cervical cerclage for cervical incompetence is majorly history indicated and most of the patients carried the pregnancies to term after cerclage insertion. The complication rate is low.

A ten year review of time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, South-East Nigeria

Cervical insufficiency is a recognised cause of third trimester miscarriage and spontaneous preterm births. It is one of the leading causes of neonatal morbidity and mortality. Miscarriage and preterm deliveries due to cervical insufficiency can be prevented by cervical cerclage insertion. The study aimed to determine the time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, south-east Nigeria. A ten year retrospective review of all women who had cervical cerclage inserted for suspected cervical insufficiency at the two tertiary health institutions in Enugu state was done. Their case files were retrieved and relevant data extracted. The mean time interval from cerclage removal at term to spontaneous onset of labour was 12 days. The majority of patients (45.6%) had spontaneous onset of labour at the 2nd week of cerclage removal. There was no significant difference in the mean time interval from cerclage removal to spontaneous onset of labour between ultrasound indicated group and history indicated group. These findings hopefully may assist in proper counselling and management of women who had cervical cerclage removed at term. Impact Statement What is already known on this subject? Cervical insufficiency is a known cause of mid trimester pregnancy loss and preterm delivery. Preterm babies are at risk of several complications, with high neonatal morbidity and mortality especially in developing world. Cervical cerclage insertion is a recognised surgical treatment for cervical incompetence aimed at preventing preterm births. What do the results of this study add? The study shows that removal of cervical cerclage at term does not result in immediate onset of spontaneous labour in women diagnosed to have cervical insufficiency. Notably, a majority of the women had spontaneous onset of labour at the 2nd weeks of cerclage removal. Only 5.3% of them had spontaneous onset of labour within 48 hours of cerclage removal. This is contrary to the general belief in the region that once cervical cerclage is removed, spontaneous onset of labour results. What are the implications of these findings for clinical practice and/or further research? This finding suggests that there is no compelling need for admission into hospital after removal of cerclage as very few of them will have spontaneous onset of labour within 48 hours of cervical cerclage removal.

The Indication for Cervical Cerclage and Pregnancy Outcome in a Teritiary Hospital in South-South Nigeria: A Five Year Review

Background: Cervical incompetence is a major cause of second trimester miscarriage. Recurrent pregnancy loss in the second trimester is associated with significant distress. However, there should be a justifiable indication before a cerclage is inserted. There is no documentation of the indication of cervical cerclage and pregnancy outcome in Yenagoa, southsouth Nigeria. Objectives: This paper focuses on documenting the indication and obstetric outcome following cervical cerclage insertion at the Federal Medical Center Yenagoa, Bayelsa State. Methodology: A 5 year retrospective study was carried out in women who had cervical cerclage for cervical incompetence in the Federal Medical Centre, Yenagoa. The study was conducted from the 1 st of January 2014 to 31st of December 2018. All the case files of patients who had cervical cerclage were retrieved and reviewed. Results: A total of 41 patients had cervical cerclage. The commonest indication for cervical cerclage insertion was history indicated cerclage 59.4%. This was followed by ultrasound indicated cerclage 28.1% and rescue cerclage accounting for 12.5%. All patients employed McDonald’s method of cervical cerclage. The position of the knot wasin 12 0’ clock position in 53.1% of the patients and in the 6 0’clock position for 46.9% of the patients. The success rate following insertion of cerclage was 79.3%. The mode of deliveries was vaginal in 90.6% of the patients and 9.4% had caesarean section. Conclusion: There may be concern about the diagnosis of cervical incompetence. However, findings from this study clearly showed that the application of cervical cerclage is associated with good obstetric outcome.

A Five-Year Survey of Cervical Cerclage at a Nigerian Tertiary Hospital

Background: Cervical incompetence is an important cause of mid-trimester miscarriage. Mid- trimester pregnancy loss is a distressing event for both parents and physician contributing significantly to perinatal mortality, hence Cervical Cerclage. Proper definition of cervical incompetence and proper patient selection will improve the outcome of cervical cerclage. Objective: To document the indications, outcome and complications associated for cervical cerclage insertion Methods and Material: A 5-year retrospective analysis undertaken on patients who had cervical cerclage for cervical incompetence at the university of Abuja teaching hospital, Gwagwalada FCT within the period spanning from January 2012 to December 2017. Case folders of patients who had cervical cerclage were retrieved from the central records. Results: In this study, 96 patients had cervical cerclage. Women within the age range of 26-30 (42.7%) had the highest cerclage insertion. Most of the cerclage were done between 14-16 weeks’ gestation (45.8%) while, 38 (39.6%) were done below 14weeks and 14 (14.6%) were done above 16weeks gestation. All patients had McDonald’s stitch. The most predominant indication for cerclage insertion being “history indicated” (78.1%). The most observed complication was pre-term labour 16 (16.7%) while majority of the patients 53 (55.2%) had no complications. The hallmark of the study was, out of the 96 women who had cervical cerclage, 14 (14.6%) had miscarriage and 82 (85.4%) delivered above the age of fetal viability. Out of the 82 patients that delivered above viability, 69 (84.1%) term deliveries, 13 (15.9%) preterm deliveries. Out of the 82 deliveries above fetal viability, there were 76 (92.7%) live births and 6 (7.3%) stillbirths. Vaginal deliveries were 61 (74.4%), while 21 (25.6%) were caesarean section. Therefore 69 (71.9%) of patients within this study had a successful cerclage. Conclusion: Cervical cerclage remains one of the most practiced and deemed effective methods of preventing and prolonging preterm births. Its outcome depends on a careful patient selection and procedure.

Effectiveness of Prophylactic Cervical Cerclage in Prolonging Higher-Order Multiple Pregnancies.

This study aimed to assess the value of prophylactic cervical cerclage in prolonging higher-order multiple pregnancies. This retrospective study included all women with higher-order multiple pregnancies beyond 24 gestational weeks treated at the King Abdullah University Hospital in Irbid, Jordan, and King Fahad Medical City in Riyadh, Saudi Arabia, between February 2014 and January 2015. Selected maternal characteristics and obstetric outcomes were compared between women who received prophylactic cervical cerclage and those who did not. A total of 146 women with higher-order multiple pregnancies were included in the study; of these, 94 (64.4%) underwent a prophylactic cervical cerclage insertion procedure and 52 (35.6%) women did not. No significant difference was found between the two groups with regards to maternal age, parity or number of fetuses. However, the mean gestational age at delivery was significantly higher for women without compared to those with prophylactic cervical cerclage (32.9 weeks versus 31.7 weeks) according to both univariate and multivariate analyses (P = 0.013 and 0.046, respectively). Additionally, 40.4% of women without and 14.9% of women with prophylactic cervical cerclage gave birth after 34 gestational weeks (P = 0.003). Overall, prophylactic cervical cerclage was not associated with prolongation of the pregnancy among women with higher-order multiple pregnancies in the current study.

Cervical cerclage for preterm birth prevention in twin gestation with short cervix: a retrospective cohort study.

To determine if cervical cerclage reduces the rate of spontaneous early preterm birth in cases of dichorionic-diamniotic (DCDA) twin gestation with an ultrasound-detected short cervix. This was a retrospective cohort study of 40 consecutive DCDA twin gestations at Saint Peter's University Hospital from November 2006 to November 2014 in which cervical cerclage was performed for an ultrasound-determined cervical length of 1-24 mm at 16-24 weeks' gestation. The cases were matched with 40 controls without cerclage for cervical length and gestational age at cervical assessment. The primary outcome measure was spontaneous birth < 32 weeks. There was no difference between the two groups in maternal age, body mass index (BMI), cigarette smoking, use of in-vitro fertilization (IVF), parity and prior spontaneous preterm birth. There were more Caucasian women among the controls compared with cases. In the cases, compared with controls, spontaneous delivery < 32 weeks was significantly less frequent (20.0% vs 50.0%; relative risk, 0.40 (95% CI, 0.20-0.80)). In the prediction of spontaneous delivery < 32 weeks, logistic regression analysis demonstrated that the risk was reduced with the insertion of cervical cerclage (odds ratio, 0.22 (95% CI, 0.058-0.835); P = 0.026), corrected for maternal age, BMI, racial origin, cigarette smoking, IVF, parity and previous preterm birth. In DCDA twin gestation with a short cervix, treatment with cervical cerclage may reduce the rate of early preterm birth. The findings suggest the need for adequate randomized controlled trials on cerclage in twin gestations with a short cervix. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

PPO.07 Evaluation of the effect of cervical cerclage insertion on quantitative cervicovaginal fetal fibronectin levels, and prediction of spontaneous preterm birth

IntroductionFetal fibronectin (fFN) testing is an established predictor for spontaneous preterm birth (sPTB). A novel bedside fFN analyser allows quantification of fFN (qfFN) concentrations. It is commonly thought that cerclage...

Outcome of pregnancy with history-indicated cervical cerclage insertion in a low-resource setting

Objective: History-indicated cervical cerclage insertion is required when factors in a woman's history could predispose to spontaneous miscarriage or preterm birth. This retrospective study determined the pregnancy outcome after insertion of history-indicated cervical cerclage for at least one previous mid-trimester spontaneous abortion over a 10-year period in a low-resource setting.Methods: This was a retrospective analysis of hospital data. Data was retrieved on biosocial and obstetrics parameters and analysed. The outcome measures were recurrence of spontaneous miscarriage, preterm delivery rate and fetal salvage rate. Descriptive frequencies were used to present results. The test of statistical significance was with Yates' coefficient correlation at 95% confidence interval.Results: Cervical cerclage rate was 7 per 1000 births. Diagnosis was clinical and cerclage was inserted at a mean gestational age of 15 ± 3.6 weeks. Hospital admission greater than five days after cerclage insertion had no statistically significant difference on preterm delivery (CI 95%; p value = 0.98). Repeat spontaneous miscarriage occurred less (5.6%) after cerclage insertion, fetal salvage rate was 75% and the preterm birth rate was 30%.Conclusion: The limitations of the study notwithstanding, use of history-indicated cervical cerclage in pregnancy resulted in better fetal salvage rate and reduced recurrence of spontaneous miscarriage.

Extreme preterm prelabor rupture of membranes: A case report

Prelabor rupture of membranes is a rare occurrence in obstetric practice, and extreme preterm prelabor rupture of membranes poses a great challenge in management to both the obstetrician and the neonatologist. A case of recent conservatively managed case of extreme preterm prelabor rupture of membranes is discussed. A 26-year-old nulliparous student with three previous history of abortions, who had prophylactic cervical cerclage insertion at 12 weeks gestational age. She later presented at the gestational age of 23 weeks with spontaneous rupture of membranes confirmed clinically and with ultrasonography. She was managed conservatively in the hospital with prophylactic antibiotics and fetal surveillance until 34 weeks of gestational age when she had an emergency cesarean section with good outcome and uneventful recovery. The management of this case is balanced between prematurity and infection, and conservative management is accepted, especially at a gestational age when prematurity from early delivery would have made survival for the fetus difficult.

PP.28 Cervical Cerclage: Are All Techniques Successful?

ObjectivePreterm birth is a global public health issue. In women considered high risk, insertion of a cervical cerclage has been shown to reduce this risk. We present findings from a...

Cervical cerclage: a successful procedure no matter which technique is used

IntroductionIn women at risk of midtrimester loss or extreme preterm birth (PTB), insertion of a cervical cerclage has been shown to reduce that risk.1 Three common techniques are used. We...

Pregnancy outcome following cervical cerclage: a four-year review

The aim was to assess pregnancy outcome in women who had an elective cervical cerclage.This was a 4 year retrospective case note review. The study group comprised singleton pregnancies where...

Comparative study of two surgical management methods for cervical incompetence at University College Hospital, Ibadan

BackgroundIncompetence of the internal uterine cervical os is associated with recurrent pregnancy loss. Different surgical techniques are in practice to correct the defect. Objective: The objective of this study therefore was to review the outcome of pregnancies following cervical using either of the two procedure among patients diagnosed as having incompetence of the cervix.&#x0D; MethodsA comparative study of 2 standard methods of cerclage used in our hospital, McDonald &amp; Shirodkar, in a group of 80 patients was done. All the patients had cervical cerclage insertion done between the 14th &amp; 16th weeks of gestation using either of the two methods.&#x0D; ResultsThere was no significant morbidity with either of the 2 methods. The overall success rates, as measured by continuation of the pregnancy to term, were smilar.&#x0D; ConclusionBoth methods of cervical cerclage are equally effective in producing the desired outcome, but since the McDonald method is technically simpler to perform, it may be desirable to adopt this approach more frequently.

Cervical incompetence: Elective, emergent, or urgent cerclage

Objective: We define criteria for insertion of cervical cerclage done electively (historical), urgently (in patients without symptoms), or emergently (in patients with symptoms). We compare outcomes as determined by prolongation of pregnancy and survival in each of these groups, and we define whether urgent or emergent cerclage imparted a higher risk of spontaneous rupture of membranes or chorioamnionitis than that associated with elective cerclage. Study Design: This is a retrospective analysis of all cervical cerclages placed at Memorial Medical Center between January 1, 1993, and December 31, 1997. Outcomes oberved were as follows: (1) prolongation of pregnancy in weeks after cervical cerclage, (2) presence of spontaneous rupture of membranes or clinical chorioamnionitis necessitating delivery, and (3) neonatal outcome. Results: For prolongation of pregnancy the following results were obtained: emergent cerclage, 8.3 ± 0.9 weeks; urgent cerclage, 12.2 ± 1.5 weeks; and elective cerclage, 20.2 ± 0.9 weeks (elective versus emergent and urgent, P < .05). For average gestational age at delivery, the results were as follows: emergent cerclage, 30.5 ± 0.9 weeks; urgent cerclage, 33.1 ± 1.4 weeks; and elective cerclage, 35.5 ± 0.9 weeks (elective versus emergent and urgent, P < .05). The total neonatal survival was 85.7%. The incidence of spontaneous rupture of membranes was as follows: emergent cerclage, 51%; urgent cerclage, 40%; elective cerclage, 18% (elective versus emergent and urgent, P < .05). The incidence of clinical chorioamnionitis showed similar results. Conclusions: It is clear that emergency cerclages confer some benefit in patients with evidence of cervical incompetence. From this study it is evident that there is a new group of patients who need cerclage on an urgent basis as shown by subtle ultrasonographic changes in the cervix. Their behavior mirrors that of those belonging to the emergent group, suggesting that if they were left untreated they would need cerclage on an emergency basis. (Am J Obstet Gynecol 1999;181:240-6.)