TITLE:
Clinical Analysis on the Effectiveness of Transvaginal Cervical Cerclage in Singleton Pregnancies and Its Predictive Factors
AUTHORS:
Neelam Kumari Shah, Chang Shu, Rambha Kumari Shah, Chen Chen, Nashiri Ramazani, Jin He
KEYWORDS:
Uterine Cervical Incompetence, Cervical Cerclage, C-Reactive Protein, Predictive Factors, Outcomes
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.3,
March
30,
2018
ABSTRACT: Objective: To evaluate the effectiveness of transvaginal cervical cerclage in
singleton pregnancies with cervical incompetence, determine the predictive
factors of success and failure, and then compare elective and emergency cerclage. Study Design: This was a retrospective study of 62 patients who underwent
cervical cerclage in The First Hospital of Jilin University, China, between May
2015 and January 2018. Successful group was defined as those who delivered live
babies and failure group who experienced abortion or stillbirth. Results: Out of 104 patients, 62 met inclusion criteria. In 62 cases, 47 (75.8%) succeeded and 15 (24.2%) failed. In
successful group, 21 (44.7%) women delivered pretermly and 26 (55.3%) termly. No severe
complications occurred except cervical laceration (2, 3.23%), premature rupture
of membranes (13, 20.97%). In 62 cases, 40 (64.5%) have ≤2 previous second-trimester losses and
22 (35.5%)
have >2 previous second-trimester losses. No significant differences were
found in neonatal outcomes. Analysis revealed that higher postoperative
C-reactive protein and presence of premature rupture of membranes were the
strongest predictors of cerclage failure. Among 62 cases, 48 (77.4%) were
allocated in elective and 14 (22.6%)
in emergency cerclage. Pregnancy prolongation was significantly more (P = 0.014)
in elective group with no significant differences in premature rupture of
membranes, neonatal outcomes (all P > 0.05) except Apgar score
at 5 min (P = 0.042). Conclusion: Achieving 75.8% live births proves that transvaginal
cervical cerclage is an effective and safe technique in prolonging the
gestational age, improving the obstetric outcomes in singleton pregnancies with
cervical incompetence under various cerclage indications. Postoperative
C-reactive protein and premature rupture of membranes are the predictive
factors related to success or failure. Elective cerclage is more effective in
prolonging the pregnancy compared to emergency cerclage, no significant
differences are seen regarding neonatal outcomes and complications.