Effects of Maternal Cervical Incompetence on Morbidity and Mortality of Very Low Birthweight Neonates

Abstract

Background: Cervical incompetence is a well-recognized cause of preterm birth, but little is known about its relationship with neonatal morbidity and mortality. Objectives: We examined the hypothesis that maternal cervical incompetence may be associated with postnatal morbidities in preterm neonates. Methods: A retrospective cohort analysis was conducted for all the preterm neonates who were admitted to our institution with a birthweight of less than 1,500 g. They were divided into two groups: one with cervical incompetence and the other without it. The outcomes of postnatal morbidity, defined as respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), bronchopulmonary dysplasia (BPD), white matter disease (WMD), retinopathy of prematurity (ROP), early sepsis, and mortality were compared. Results: Two hundred and four neonates were eligible for this study: 80 of them were with cervical incompetence and 124 were without it. Gestational age and birthweight were earlier and lower in the cervical incompetence group (27.3 ± 2.0 vs. 29.5 ± 2.7 weeks, p < 0.000; 1,043.1 ± 247.0 vs. 1,142.2 ± 253.4 g, p = 0.006). There were no differences in the incidence of RDS (p = 0.067), PDA (p = 0.095), WMD (p = 0.601), and mortality (p = 0.403). BPD (p = 0.027), ROP (p = 0.026) and early sepsis (p = 0.002) were significantly different. However, when the incidences were stratified by gestational age [<28 weeks vs. 28–29 (+6) weeks vs. ≧30 weeks], the results were similar in both groups including BPD, ROP, and early sepsis. Conclusion: We found that cervical incompetence does not negatively affect the postnatal adverse outcomes and mortality after stratified analysis by gestational age.

Bronchopulmonary dysplasia: how can we improve its outcomes?

“…The best way to prevent the development of BPD is to prevent preterm delivery. Pharmacological interventions such as the administration of antibiotics, use of vaginal prostaglandin suppository, tocolytic agents such as magnesium sulfate, and surgical interventions like cervical cerclage for cervical incompetence may also prevent preterm birth [30,31].…”