An audit of the contemporaneous practice of cervical cerclage in a tertiary care hospital in Mumbai

Vandana Bansal; Pooja S.; Meera Agalawe; Aishwarya Kadrekar; Ashwini Patel

doi:10.18203/2320-1770.ijrcog20263419

Authors

Vandana Bansal Department of Obstetrics and Gynecology and Fetal Medicine, Nowrosjee Wadia Maternity Hospital and Seth G. S. Medical College, Parel, Mumbai, Maharashtra, India
Pooja S. Department of Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital and Seth G. S. Medical College, Parel, Mumbai, India
Meera Agalawe Department of Fetal Medicine, Nowrosjee Wadia Maternity Hospital, Parel, Mumbai, Maharashtra, India
Aishwarya Kadrekar Department of Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital and Seth G. S. Medical College, Parel, Mumbai, India
Ashwini Patel Department of Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital and Seth G. S. Medical College, Parel, Mumbai, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20263419

Keywords:

Cerclage, Cervical incompetence, Cervix, Preterm

Abstract

Background: Cervical incompetence refers to the inability of the cervix to support a full-term pregnancy due to functional or structural defect of the cervix.

Methods: Prospective observational study conducted at a tertiary hospital of all consecutive patients who underwent cerclage during 18 months period. The pregnant women were followed-up through their antenatal and immediate postnatal period and perinatal outcomes were assessed.

Results: Of the total 60 patients in the study, 25 patients continued till full term (41.6%). 27 patients (45%) delivered preterm and 8 (13.3%) aborted after cerclage. 40% had conceived with assisted reproductive techniques, 41.6% were primigravida and 35% had history of previous cervical incompetence. 35% patients had multifetal gestations. Mean gestational age at cerclage was 17.4±3.6 weeks. Mean cervical length was 2.8±0.79 cm. Most common reason for opting cerclage was ultrasound indicated. 96% underwent Macdonald’s cerclage. The difference in outcomes with use of either Polyester fibre tape and black braided silk was not statistically significant. Ultrasonographic surveillance of cervical length post-cerclage placement did not impact clinical practice. 81% babies went home alive, mean birth weight was 2027±828 gram, 51% required NICU admission. Incompetence related preterm deliveries happened in 46.6% patients in spite of a cerclage. The mean gestational age at delivery in singleton was 34.4±4.6 weeks, while it was much less (30.5±6.5 weeks) in multifetal pregnancies

Conclusions: Cervical cerclage improves pregnancy outcome in carefully selected patients. Outcomes following cerclage could be unfruitful in few, while others may have a complicated antenatal period.

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