Cervical cerclage for cervical insufficiency: methods and pregnancy outcomes at a tertiary hospital in South-Western Nigeria
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20250160Keywords:
Incidence, Cervical incompetence, Methods of cerclage, Complications, Pregnancy outcomeAbstract
Background: A ‘gold standard’ for the treatment of cervical insufficiency is by inserting cervical cerclage. This intervention may not be successful in all cases. Hence, there is a need to assess the methods and pregnancy outcomes of cervical cerclage, and draw conclusion from the findings. Objectives were to assess the methods and pregnancy outcome of cervical cerclage in women with cervical incompetence at the federal teaching hospital, Ido-Ekiti, Ekiti State.
Methods: This is a 5-year retrospective review of the records of women that had cervical cerclage between June 2019 and June 2024. The data were retrieved and analyzed for their socio-demographic factors, clinical characteristics, landmark past clinical events, number of past cerclage insertions, and the methods and pregnancy outcomes of index cerclage. The data obtained were analyzed using SPSS version 26.
Results: There were 27 cases of cerclage placement per 2,489 deliveries (1 in 92 births) during the period under review. The mean age was 33.6±4.8 years. Majority (74.1%) aged 31 to 40 years. Two-thirds of women (66.7%) had no prior births, 25.9% had one birth, and 7.4% had two or more births. The McDonald’s technique was the most commonly used method, accounting for 92.6% of cases. Favourable outcome was recorded in 85.2% of the women.
Conclusions: This study showed that majority of the women treated with cerclage had successful pregnancy outcome, further supporting this intervention as a “gold standard” for managing cervical incompetence.
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References
Brown R and Gagnon R Delisle R. No. 373-cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2019;41(2):233-47. DOI: https://doi.org/10.1016/j.jogc.2018.08.009
Nkyekyer K. Cervical incompetence. In: Kwaukume EY, Ekele BA, Danso KA, Emuveyan EE, eds. Comprehensive Obstetrics in the tropics. 2nd ed. Accra-North, Ghana: Assemblies of God Literature Centre Ltd. 2015;415-20.
Oriji PC, Briggs DC, Allagoa DO, Atemie G. Cervical Insufficiency and Perinatal Outcome in a Tertiary Hospital in Yenagoa, South-South, Nigeria. Asian Res J Gynaecol Obstet. 2021;6(4):5-13. DOI: https://doi.org/10.9734/ajmah/2021/v19i930368
Dimejesi IBO, Onwe AB. Cervical Incompetence. In: Umeora OUJ, Egbuji CC, Onyebuchi AK, Ezeonu PO, eds. Our Teachers- A comprehensive textbook of Obstetrics and Gynaecology. Is ted. Abakaliki, Nigeria: ST Benedict Printing and publishing. 2017;397-400.
Zardad B, Fawad A, Ismail A, Mehreen S and Bibi S. Causes of mid-trimester pregnancy loss in a tertiary care hospital. JSTMU. 2020;3(2):64-9. DOI: https://doi.org/10.32593/jstmu/Vol3.Iss2.76
Adeniran AS, Aboyeji AP, Okpara EU, Fawole AA, Adesina KT. Pregnancy outcome in cervical incompetence: Comparison of outcome before and after intervention. Trop J Obstet Gynaecol. 2014;31(1):23-28.
Rechberger T, Uidbjerg N, Oxlund H. Connective tissue changes during normal pregnancy and pregnancy complicated by cervical incompetence. Obstet Gynaeco. 1988;71:563-7.
Shennan AH, Story L. the Royal College of Obstetricians, Gynaecologists. Cervical Cerclage. BJOG. 2022;129:1178-210. DOI: https://doi.org/10.1111/1471-0528.17003
Yanamandra N and Arulkumaran S. Cervical Cerclage. Curr Obstet Gynaecol. 2006;16:306-8. DOI: https://doi.org/10.1016/j.curobgyn.2006.07.007
Simcox R and Shennan A. Cervical cerclage in the prevention of preterm birth. Best Pr Res Clin Obstet Gynaecol. 2007;21:831-42. DOI: https://doi.org/10.1016/j.bpobgyn.2007.03.009
Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. National Institute of Child Health and Human Development Maternal Fetal Medicine Unit Network. N Engl J Med. 1996;334(9):567-72. DOI: https://doi.org/10.1056/NEJM199602293340904
Shirodkar V. A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic. 1955;52:299-300.
McDonald I. Suture of the cervix for inevitable miscarriage. Br J Obstet Gynecol. 1957;64(3):346-50. DOI: https://doi.org/10.1111/j.1471-0528.1957.tb02650.x
Benson RC, Durfee RB. Transabdominal cervico-uterine cerclage during pregnancy for the treatment of cervical incompetence. Obstet Gynecol. 1965;25:145-55.
Lash AF, Lash SR. Habitual abortion; the incompetent internal os of the cervix. Am J Obstet Gynecol. 1950;59(1):68-76. DOI: https://doi.org/10.1016/0002-9378(50)90342-5
Ikechebulu JI, Dim CC, Okpala BC, Eleje GU, Joe-Ikechebulu NN, Echezona DM, et al. Comparison of pregnancy outcomes of triangular 3-bites and McDonald techniques of cervical cerclage in women with cervical insufficiency: A pilot study. Niger J Clin Pract. 2023;26:630-5. DOI: https://doi.org/10.4103/njcp.njcp_830_22
Damalie FJMK, Senaya CM, Dassah ET, Konney TO, Ameyaw E, Larsen-Reindorf R, et al. Double cervical cerclage for cervical insufficiency: Case report. Afr J Reprod Health. 2024;28(6):117-25.
Arnold KC, Flint CJ. Cerclage for the Management of Cervical Insufficiency. Obstet Essent. 2017;123(2 Pt 1):372-9.
ACOG Practice Bulletin No, 142: Cercalge for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2):372-9. DOI: https://doi.org/10.1097/01.AOG.0000443276.68274.cc
Swati R, Ritu K. Cervical Cerclage: Indications and Techniques. AOGD Bull. 2017;17(4):42.
Secher NJ, Mc Cormack CD, Weber T. Cervical occlusion in women with cervical incompetence: Proposal for a randomized controlled trial with cerclage; with or without cervical occlusion. BJOG. 2007;114:649-e6. DOI: https://doi.org/10.1111/j.1471-0528.2007.01250.x
Feyi-waboso PA, Umerurike CC. Management of cervical incompetence in Aba, South Eastern Nigeria. Niger J Med. 2005;14:400-40. DOI: https://doi.org/10.4314/njm.v14i4.37196
Wekere FCC, Clement-Wekere GAF, Nonye-Enyiah EI. Cervical incompetence: prevalence, socio-demographic and clinical characteristics in Rivers STATE University Teaching Hospital, Port Harcourt, South-South Nigeria. Yen Med J. 2020;2(1):127-34. DOI: https://doi.org/10.9734/jammr/2019/v31i430292
Hortu I, Sahin C, Ilgen O, Kazandi M, Akdemir A, Ergenoglu AM. Double cerclage in cervical insufficiency: a single tertiary center experience. Gynaecol Obstet Reprod Med. 2020;26(2). DOI: https://doi.org/10.21613/GORM.2019.953
Ayegbusi OE. Laparoscopic Cerclage in pregnant and nonpregnant uterus: Emerging Need to change Conventional Management Approach. Word J Lap Surg. 2017;10(1):35-9. DOI: https://doi.org/10.5005/jp-journals-10007-1299
Alani S, Wang J, Suarthana E, Tulandi T. Complications Associated with Cervical cerclage: A systematic Review. Gynecol Minim Invasive Ther. 2023;12(1):4-9. DOI: https://doi.org/10.4103/gmit.gmit_61_22
Bhatia R, Borole S, Sherar N. Uterine rupture: A rare complication of repeated cervical cerclage. IJOGR 2022;9(1):127-30. DOI: https://doi.org/10.18231/j.ijogr.2022.026
Van Dijk CE, Breuking SH, Sophie J, Limpens JCEM, Kazemier BM, Pajkrt E. Perioperative complications of a transvaginal cervical cerclage in singleton pregnancies: a systematic review and meta-analysis. AJOG. 2023;228(5):521-34. DOI: https://doi.org/10.1016/j.ajog.2022.10.026
Waloch M. Cervical cerclage in the treatment of cervical incompetence in Zambian women. Clinc Exp Obstet Gynecol. 1996;23:233-62.
Sobande AA, Archibong EI, Sadek A, NH Singagli, Akinola SE. A clinic-epidemiological review of cervical cerclage from the Assir region of Saudi-Arabia. J Obstet Gynecol. 2002;22(2):150-4. DOI: https://doi.org/10.1080/01443610120113283
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