Citation Information :
Memon Z, Anjum N, Hoodbhoy Z. Pregnancy Outcomes of Patients with Ultrasound-indicated and History-indicated McDonald Cervical Cerclage. J South Asian Feder Obs Gynae 2022; 14 (5):541-544.
Objective: To assess pregnancy outcomes of patients with ultrasound-indicated and history-indicated McDonald cervical cerclage.
Materials and methods: This was a cross-sectional study of pregnant women who had cervical cerclage performed at Aga Khan University Hospital, Karimabad campus. We obtained Institutional Review Board approval and reviewed the medical records of patients. A purposive continuous sampling technique was used. A total of 88 patients were included. There were no exclusion criteria. Outcome data were collected from the medical record of patients from January 2010 to December 2016.
Results: Analysis reported a statistically significant lower gravidity and parity in the scan-indicated group as compared with other groups (p = 0.000 and p = 0.001, respectively). Previous history of cervical cerclage, history of mid-trimester miscarriage, and preterm labor were significantly associated with indication for cerclage (p = 0.001, 0.046, and 0.001, respectively). Cervical length was also significantly associated with the indication for cerclage (p <0.001). Lower gestational age at previous abortion in the history-indicated group as compared with other groups (p = 0.003 and <0.001, respectively). Pregnancy prolongation was significantly lower in the scan-indicated group as compared with other groups (p = 0.04 and 0.004, respectively).
Conclusion: Our study showed that patients with a history suggestive of cervical incompetence or short cervix on ultrasound should be offered cerclage to prevent preterm birth and to improve neonatal outcomes. Ultrasound-indicated cerclage after the first trimester indicates that universal cervical-length screening by transvaginal ultrasound in the mid-trimester can pick silent cases, and inserting cerclage can prolong pregnancy to term.
Clinical significance: Screening cervical length will help clinicians to reduce preterm birth rate, especially in resource-limited underdeveloped countries.
Berghella V, Seibel-Seamon J. Contemporary use of cervical cerclage. Clin Obstet Gynecol 2007;50(2):468–477. DOI: 10.1097/GRF.0b013e31804bddfd.
Harger JH. Comparison of success and morbidity in cervical cerclage procedures. Obstet Gynecol 1980;56(5):543–548. PMID: 7001296.
Nelson L, Dola T, Tran T, et al. Pregnancy outcomes following placement of elective, urgent and emergent cerclage. J Matern-Fetal Neonatal Med 2009;22(3):269–273. DOI: 10.1080/14767050802613199.
Berghella V, Odibo AO, Tolosa JE. Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: A randomized trial. Am J Obstet Gynecol 2004;191(4):1311–1317. DOI: 10.1016/j.ajog.2004.06.054.
Ruchika Garg, Anushree Rawat, Pavika Lal, et al. Evidence-based approach for preventing preterm birth: Cervical stitch (Cerclage) vs role of Arabin Pessary for cervical insufficiency. J South Asian Feder Obst Gynaecol 2020;12(1):1–4. DOI: 10.5005/jp-journals-10006-1745.
lams JD, Goldenberg RL, Meis PJ, 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):567–572. DOI: 10.1056/NEJM199602293340904.
Green-top Guideline. The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. No.17. April 2011.
Romero R, Espinoza J, Erez O, et al. The role of cervical cerclage in obstetric practice: Can the patient who could benefit from this procedure be identified? Am J Obstet Gynecol 2006;194(1):1–9. DOI: 10.1016/j.ajog.2005.12.002.
Hassan SS, Romero R, Berry SM, et al. Patients with an ultrasonographic cervical length ≤15 mm have nearly a 50% risk of early spontaneous preterm delivery. Am J Obstet Gynecol 2000;182(6):1458–1467. DOI: 10.1067/mob.2000.106851.
Berghella V, Odibo AO, To MS, et al. Cerclage for short cervix on ultrasonography: Meta-analysis of trials using individual patient-level data. Obstet Gynecol 2005;106(1):181–189. DOI: 10.1097/01.AOG.0000168435.17200.53.
Aniket Kakade, Yashwant Kulkarni, Anmol Mehra. Forgotten Transvaginal Cervical Cerclage Stitch in First Pregnancy Benefits reaped till the Second Pregnancy. J South Asian Feder Obst Gynaecol 2017;9(2):135–136. DOI: 10.5005/jp-journals-10006-1479.
Poggi SH, Vyas N, Pezzullo JC, et al. Therapeutic cerclage may be more efficacious in women who develop cervical insufficiency after a term delivery. Am J Obstet Gynecol 2009;200(1):68.e1–68.e3. DOI: 10.1016/j.ajog.2008.08.005.
To MS, Palaniappan V, Skentou C, et al. Elective cerclage vs ultrasound-indicated cerclage in high-risk pregnancies. Ultrasound Obstet Gynecol 2002;19(5):475–477. DOI: 10.1046/j.1469-0705.2002.00673.x.
Owen J, Hankins G, Iams JD, et al. Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009;201(4):375.e1–375.e8. DOI: 10.1016/j.ajog.2009.08.015.
Incerti M, Ghidini A, Poggi SH, et al. Cervical length <25 mm in low risk women: A case-control study of cerclage vs rest. Am J Obstet Gynecol 2006;195(6):S59. DOI: 10.1016/j.ajog.2006.10.180.