Cervical Cerclage Results of the Last Ten Year Period (1997–2008) in Faculty Hospital Olomouc

Česká verzia

Authors: M. Větr
Authors place of work: Gynekologicko-porodnická klinika LF UP a FN Olomouc, přednosta prof. MUDr. M. Kudela, CSc
Published in the journal: Ceska Gynekol 2008; 73(4): 209-213

Summary

Objective:
To evaluate the effectiveness of the cervical cerclage in the last ten year period on pregnancy outcome.

Study design:
Retrospective study.

Setting:
Gynaecological and Obstetric Clinic Medical Faculty Palacky University and Faculty Hospital Olomouc.

Methods:
In the retrospective analysis of maternal and newborn records in the ten year period from 1. 1. 1998 to 31. 12. 2007 were identified three groups of indications for operative cervical closure: elective – on the basis of history without objective evidence of cervical change, emergency cerclage – with objective manifestation of cervical insufficiency and rescue cerclage of a widely dilated cervix with prolapsed unruptured membranes.

Results:
A total 102 patients underwent cerclage between 11 and 31 weeks gestation. The prevalence of operative intervention was 0,6% of all mothers. Cervical cerclage was done by the McDonald technique.

17 patients had elective operations, 57 emergency and 28 rescue cerclage. Median length of interval from cerclage to delivery was significantly shorter after rescue cerclage, 26 days, (range 2-126) compared to emergency cerclage patients, 74 days (range (7-148). (P= 0,000005). Median interval from cerclage to delivery in elective operation was 105 days (range 9-188).

Newborn dates corresponds with earlies termination of pregnancy in rescue cerclage subjects, with median gestational age at time of delivery 28 weeks (range 19-41), after emergency operation median achieved 36 weeks (range 23-41). The median gestational age at delivery after elective cerclage was 36 weeks (range 22-41). Nine fetal losses were in the rescue group, sex abortions (from 260 to 560 grams) and three early neonatal deaths (530, 550, 1150 grams).

Conclusion:
These results confirm that the use of cervical cerclage in prevention of the premature labour is rather rare as well as achievement outcomes did not fulfil our expectations. This fact could have been considered in the care of pregnant and lead to restriction of unnecessary investigations of uterine cervix especially in non risk and asymptomatic population.

Key words:
cervical cerclage, elective, emergency, rescue, retrospective analysis.

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