Elective and emergency cervical cerclage and pregnancy outcomes-a prospective observational study

Deepika Theresa Thomas; Preet Agarwal

doi:10.18203/2320-1770.ijrcog20243763

Authors

Deepika Theresa Thomas Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
Preet Agarwal Department of Obstetrics and Gynecology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20243763

Keywords:

Cervical length, Cerclage, Gestational age at delivery

Abstract

Background: Aim of the study was to analyze the prolongation of pregnancy (the mean cerclage to delivery interval) after elective and emergency cervical cerclage and to analyze the maternal and fetal outcome following cerclage.

Methods: It is a prospective observational study conducted in the Department of Obstetrics and Gynecology at Sri Ramachandra Medical College among 130 patients who underwent cervical cerclage at our hospital. History of previous preterm deliveries, abortions, recent ultrasonography (USG) cervical length findings noted. The USG findings of cervical length, funneling, ballooning of membrane and internal os diameter has been recorded. Cerclage related details like gestational age at suture, cerclage to delivery interval, type of suture material, method of cerclage, gestational age at delivery and neonatal outcomes has been noted.

Results: In the USG and history-based cerclage group, prolongation of pregnancy was a mean of 21 weeks, and majority-77.8% delivered at term, compared to the rescue cerclage group where prolongation was a mean of 10 weeks, and majority-76.2% had late preterm deliveries.

Conclusions: Albeit rescue cerclages known to be associated with infections, rupture of membranes, preterm labor/preterm premature rupture of membranes (PPROM), it has significantly reduced the perinatal morbidity and mortality by prolongation of pregnancy to at least late preterm, in most patients, in this present study.

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References

Wood SL, Owen J. Cerclage: Shirodkar, McDonald, and Modifications. Clin Obstet Gynaecol. 2016;59(2):302-10.

Daskalakis G, Papantoniou N, Mesogitis S, Antsaklis A. Management of cervical insufficiency and bulging fetal membranes. Obstet Gynecol. 2006;107(2):221-6.

Timofeev J. Use of cervical pessary in the management of cervical insufficiency. Clin Obstet Gynaecol. 2016;59(2):311-9.

Abenhaim HA, Tulandi T. Cervical insufficiency: re-evaluating the prophylactic cervical cerclage. J Maternal Fetal Neonat Med. 2009;22(6):510-6.

Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women. Cochrane Database Syst Rev. 2003;2003(1):CD003253.

Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R. Obstetrical emergency outcomes compared with elective cervical cerclage. J Maternal Fetal Neonat Med. 2017;30(14):1650-4.

Hashim HA, Al-Inany H, Kilani Z. A review of the contemporary evidence on rescue cervical cerclage. Int J Gynecol Obstet. 2014;124(3):198-203.

Sarri G, Davies M, Gholitabar M, Norman JE. Preterm labor: summary of NICE guidance. BMJ. 2015;351.

Katharina P, René H, Janis K, Tina F, Martin PP. Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines. BMC Pregnancy Childbirth. 2022;22(1):1-9.

Shennan A, Story L, Jacobsson B, Grobman WA, FIGO Working Group for Preterm Birth, Simpson JL, Norman J, Bianchi A, Munjanja S, González CM, Mol BW. FIGO good practice recommendations on cervical cerclage for prevention of preterm birth. Int J Gynecol Obstet. 2021;155(1):19-22.

Suhag A, Berghella V. Cervical cerclage. Clin Obstet Gynecol. 2014;57(3):557-67.

Giraldo-Isaza MA, Berghella V. Cervical cerclage and preterm PROM. Clin Obstet Gynecol. 2011;54(2):313-20.

Groom KM, Shennan AH, Bennett PR. Ultrasound -indicated cervical cerclage: outcome depends on preoperative cervical length and presence of visible membranes at time of cerclage. Am J Obstet Gynecol. 2002;187(2):445-9.

Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women. Cochrane Database Syst Rev. 2003;2003(1):CD003253.

Wierzchowska-Opoka M, Kimber-Trojnar Ż, Leszczyńska- Gorzelak B. Emergency cervical cerclage. J Clin Medic. 2021;10(6):1270.

Guzman E, Forster JK, Vintzileos AM, Ananth CV, Walters C, Gipson K. Pregnancy outcomes in women treated with elective versus ultrasound‐ indicated cervical cerclage. Ultrasound Obstet Gynecol. 1998;12(5):323-7.

Allagoa D, Agbo J. The Indication for Cervical Cerclage and Pregnancy Outcome in a Tertiary Hospital in South-South Nigeria: A Five-Year Review. Eur Sci J. 2019;15(24):200-6.

Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta - analysis. Obstet Gynecol. 2011;117(3):663-71.

Brown JA, Pearson AW, Veillon EW, Rust OA, Chauhan SP, Magann EF, Morrison JC. History- or ultrasound- based cerclage placement and adverse perinatal outcomes. J Reprod Med. 2011;56(9-10):385-92.

Adewole N, Isah AD, Okochi O. A five - year survey of cervical cerclage at a Nigerian Tertiary Hospital. J Gynecol Reprod Med. 2018;2(1):1-5.

Arisoy R, Yayla M. Transvaginal sonographic evaluation of the cervix in an asymptomatic singleton pregnancy and management options in the short cervix. J Pregnancy. 2012;2012:201628.

Nelson L, Dola T, Tran T, Carter M, Luu H, Dola C. Pregnancy outcomes following elective, urgent and emergent cerclage placement. J Maternal Fetal Neonat Med. 2009;22(3):269-73.

Althuisius SM, Dekker GA, Hummel P, van Geijn HP. Cervical incompetence prevention randomized cerclage trial: Emergency cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol. 2003;189(4):907-10.

Liddiard A, Bhattacharya S, Crichton L. Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study. JRSM Short Rep. 2011;2(11):1-6.

Israfil- Bayli F, Toozs-Hobson P, Lees C, Slack M, Ism ail KM. Pregnancy outcome after elective cervical cerclage with a type of suture material used. Medical Hypotheses. 2013;81(1):119-21.

Jenkins TM, Berghella V, Shlossman PA, Mc Intyre CJ, Maas BD, Pollock MA, et al. Timing of cerclage removal after preterm premature rupture of membranes: maternal and neonatal outcomes. Am J Obstet Gynecol. 2000;183(4):847-52.

Abdelhak YE, Aronov R, Roque H, Young BK. Management of cervical cerclage at term: remove the suture in labor? J Perinat Med. 2000;28(6):453-7.

Çavuş Y, Uysal A, Balsak D, Acar Z, İnce Z, Uysal F. Emergency cervical cerclage: effect on pregnancy outcome and mode of delivery. J Maternal Fetal Neonat Med. 2014;27(1):80-3.

Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: a meta- analysis of trials using individual patient-level data. Obstet Gynecol. 2005;106(1):181-9.

Wang S, Feng L. A single-centre retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency. Int J Gynecol Obstet. 2017;139(1):9-13.