Publication:

A retrospective cohort study on the outcome of cervical cerclage in patients with recurrent pregnancy loss

Background This study aimed to evaluate pregnancy outcomes after cervical cerclage in patient with recurrent pregnancy loss (RPL). Objectives were to estimate the incidence of cervical cerclage done among patients with history of RPL attending Royal hospital over the last 10 years (2013-2022). And to assess the effectiveness of cervical cerclage done among patient with RPL.

Methods Retrospective cohort study was conducted. The study was carried out from January 1, 2013, to December 31, 2022, at Royal hospital. All booked pregnant women with history of RPL who had cervical cerclage attending antenatal clinic at Royal hospital during the study period were included in the study. A set of prespecified risk factors (internationally well-known risk factors for cervical incompetence) was identified. Patients were grouped according to the presence or absence of risk factors for cervical incompetence. Both groups were followed up till end of pregnancy.

Results The overall incidence of cervical cerclage done among patient with RPL was 4.5%. Patient with history of RPL and with nil risk factors for cervical incompetence who had cervical cerclage were 11 patients (10.3%) in compared to other group which were 96 patients (89.7%). History of second trimester miscarriage being the most common risk factor for cervical incompetence (72%), and the least common risk factors were fibroid uterus (2.8%), uterine anomalies (2.8%), PCOS (2.8%) in the study. The rate of live birth after cervical cerclage insertion (elective or rescue) in patients with history of RPL in total was 92.5%. The percentage of neonatal morbidity and mortality was 28.6%. Patients with bulging membranes at the time of cervical cerclage insertion who had live birth were 80% (40% term birth, 40% preterm birth) (p=0.197). Patients with funneling cervix at the time of cervical cerclage insertion who had live birth were 93.8% (68.8% term birth, 25% preterm birth) (p=0.589).

Conclusions Elective cervical cerclage is recommended in patient with history suggestive of cervical incompetence. As rescue cervical cerclage helped in prolongation of pregnancy till term or late preterm in most of the cases, so cervical assessment is recommended in patients with RPL. Adding progesterone did not show any significant benefit in compared to other group without progesterone, but in view of small sample size further prospective study should be conducted with larger sample size. Screen for genitourinary infections is recommended and to treat accordingly.