Effectiveness of cervical encerclage and its perinatal outcome-A cohort study

Abstract

Cervical incompetence is the inability of cervix to support a full term pregnancy. The patient presents with a partially dilated cervix, with or without a history of recurrent mid trimester losses or preterm births. It is believed thatthe forced mechanical closure of an ‘incompetent’ cervix with a suture maintains the cervical length, thus preventing preterm labor. To evaluate effectiveness of cervical encerclage in women with cervical incompetence and its perinatal outcomes.This ambispective cohort study was conducted in the department of Obstetrics and Gynecology, Amala Institute of Medical Sciences, Thrissur. Medical records were reviewed during the period of 2008-201. 79 cases were included in this study.Clinical data, gestational age, cervical dilatation at the time of cerclage, cerclage-delivery interval, gestational age at the time of delivery, birth weight and maternal complications, were collected. Mean gestational age at the time of cerclage is 18.686 ±4.0200 weeks. Mean cerclage - delivery interval is18.510 ±6.3026 weeks. Cerclage delivery interval in prophylactic cases is 20.13 ±3.79 weeks and in rescue cerclages it is 9.487± 2.73 weeks. Prophylactic cerclage is more effective than rescue cerclages (p=0.0002). Mean gestational age at delivery is 36.666 ±5.3354 weeks. 23cases (29%) had low birth weight babies (<2500 gm). No maternal complications were noted in the study. 12 cases(14%) showed preterm complications. 8cases (10%) resulted in fetal demise.Based on this study we conclude that cerclage is beneficial in prolonging pregnancy with a consequent reduction of fetal losses and neonatal deaths.