Publication:

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

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.