The efficacy of cervical encerclage on the course of labour in well selected cases: a prospective study at a tertiary care hospital

Abstract

INTRODUCTIONRecurrent second trimester abortions and preterm delivery, continue to haunt as two major problems for modern obstetrics and perinatal medicine. Cervical insufficiency or incompetency is defined as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor.1 It is characterized by a painless opening and shortening of the cervix uteri between 16 to 28 weeks of gestation resulting in pregnancy wastage. 2This operation for repair of cervical internal os was first described by Palmer and Lacomme.3 Lash and Lash published a paper on habitual abortions due to cervical incompetence. 4 Shirodkar described his new operative technique for managing cervical incompetence. The incidence reported by various authors for this entity differs from 1:54 to 1:222 pregnancies. [6][7][8][9] In the second trimester, it is responsible for 15-20% of the total abortions. Cervical encerclage is considered as a simple but useful minor surgical procedure for improving the fetal salvage in proven cases of cervical incompetence. ABSTRACT Background:The two major problems for modern obstetrics and perinatal medicine are recurrent second trimester abortions and preterm delivery. Cervical insufficiency or incompetency is defined as the inability of the uterine cervix to retain a pregnancy in the absence of contractions or labor. Cervical encerclage is a simple but a resourceful procedure for improving the fetal outcome in cases proven with cervical incompetence, is a boon to modern obstetrics. Methods: A prospective analytical study was carried out at tertiary care teaching hospital for a period of ten years. Three hundred and twenty cases of bad obstetric history (repeated abortions, preterm labor) with previous pregnancy losses probably due to cervical incompetence or ultrasonographical evidence of short cervix were included in the study. These cases were subjected to cervical encerclage operation in the second trimester. Results: Out of the 289 cases, who underwent McDonald's procedure, 12 women had abortion, 66 had preterm labor and 211 women reached term. Out of the 31 cases who underwent Wurm's procedure; 4 had abortion, 17 had preterm delivery and 10 women reached to term. In the present study, the average interval from cerclage to delivery was 115 days. It was observed that the fetal salvage rate was unsatisfactory in women having short cervix with open internal os before encirclage. Infant salvage rate in this study after encerclage operation was 86%. Conclusions: Cervical encerclage when done in properly selected cases, results in improvement in fetal salvage up to eighty percent.

The Influence of Threatened Miscarriage on Pregnancy Outcomes: A Retrospective Cohort Study in a Nigerian Tertiary Hospital

“…Furthermore, the success of emergency cervical cerclage insertion in preventing pregnancy loss in patients with TM is controversial. When prophylactic cerclage placement is offered to patients with ultrasound evidence of short or insufficient cervix, pregnancy outcome may improve, but its use in women with TM confers no significant benefit [ 25 , 26 ]. Similarly, there have been conflicting reports on the effectiveness of progesterone in the treatment of TM.…”

Fetomaternal Outcome in Patients With Threatened Abortion in a Tertiary Care Center in South Kerala

“…Furthermore, the victories of emergency cervical cerclage insertion in inhibiting pregnancy injury among women with threatened abortion are provocative. When prophylactic cerclage placement is presented to women with ultrasonographical evidence of little or inadequate cervix, pregnancy outcomes can be improved, but its use in these pregnant women with threatened abortion converses no substantial value [23,24]. Correspondingly, there were contradictory reports on the efficiency of progesterone in threatened abortion.…”