Outcome of pregnancy with history-indicated cervical cerclage insertion in a low-resource setting

Okusanya, Babasola O; Isabu, P

doi:10.3109/14767058.2014.915936

Cited by 3 publications

(4 citation statements)

References 12 publications

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“…29 Previable and preterm delivery rates in this study were 7.5% and 17.5% respectively, However, an earlier study in Lagos southwest Nigeria found a lower pre-viable delivery rate of 5.6% but a higher preterm birth rate of 30%. 31 In our study, 75% of our clients sustained their pregnancies till term hence the increased incidence of spontaneous vaginal delivery in 62.5% of our clients on cervical cerclage while only 30% had either elective or emergency cesarean delivery. Cervical cerclage placement was successful in 75% of our clients while in 25% we had failed cerclage.…”

Section: Discussionmentioning

confidence: 52%

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Ade-Ojo,

Okunola,

Odetola

et al. 2024

OGIJ

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Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

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Section: Discussionmentioning

confidence: 52%

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Ade-Ojo,

Okunola,

Odetola

et al. 2024

OGIJ

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“…In a similar study in Abuja North Central Nigeria, (75) 78.1% of the women had history indicated cerclage, (21) 21.9% had rescue cerclage, while none had ultrasound indicated cerclage (Adewole et al, 2018). In other studies in Irua, Edo State South-South Nigeria and Nairobi Kenya, most of the patients had history indicated cerclage (Okusanya & Isabu, 2015;Kaura et al, 2013). The high number of patients that had history indicated cerclage in these studies may be due to the fact that ultrasound scan was used for few patients in the studies.…”

Section: Discussionmentioning

confidence: 88%

“…The major finding in our study was the success rate of 79.3% following cervical cerclage. Most studies have similar success rate (Ikimalo et al, 2012;Adewole et al, 2018;Okusanya & Isabu, 2015). This is a major pointer to the effectiveness of cervical cerclage in preventing midtrimester pregnancy loss and preterm labour.…”

Section: Discussionmentioning

confidence: 96%

The Indication for Cervical Cerclage and Pregnancy Outcome in a Teritiary Hospital in South-South Nigeria: A Five Year Review

Allagoa

Agbo

2019

ESJ

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Background: Cervical incompetence is a major cause of second trimester miscarriage. Recurrent pregnancy loss in the second trimester is associated with significant distress. However, there should be a justifiable indication before a cerclage is inserted. There is no documentation of the indication of cervical cerclage and pregnancy outcome in Yenagoa, southsouth Nigeria. Objectives: This paper focuses on documenting the indication and obstetric outcome following cervical cerclage insertion at the Federal Medical Center Yenagoa, Bayelsa State. Methodology: A 5 year retrospective study was carried out in women who had cervical cerclage for cervical incompetence in the Federal Medical Centre, Yenagoa. The study was conducted from the 1 st of January 2014 to 31 st of December 2018. All the case files of patients who had cervical cerclage were retrieved and reviewed. Results: A total of 41 patients had cervical cerclage. The commonest indication for cervical cerclage insertion was history indicated cerclage 59.4%. This was followed by ultrasound indicated cerclage 28.1% and rescue cerclage accounting for 12.5%. All patients employed McDonald's method of cervical cerclage. The position of the knot was in 12 0' clock position in 53.1% of the patients and in the 6 0'clock position for 46.9% of the patients. The success rate following insertion of cerclage was 79.3%. The mode of deliveries was vaginal in 90.6% of the patients and 9.4% had caesarean section. Conclusion: There may be concern about the diagnosis of cervical incompetence. However, findings from this study clearly showed that the application of cervical cerclage is associated with good obstetric outcome.

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“…Similar results were found in the literature regarding history-indicated elective cerclage, achieving prevention of second trimester loss (STL) or preterm birth (PTB) in two thirds of low-risk groups (defined by one or two prior STL or PTB or by one previous successful cerclage). [6][7][8] In this study one limitation may result from indication criteria. The indication for cerclage was at least one previous second trimester spontaneous pregnancy loss where no other cause was identified, conflicting with some recommendations were history of more pregnancy losses is required, hampering comparison.…”

Section: Discussionmentioning

confidence: 99%

History-indicated transvaginal cerclage: results from a single-centre

Gomes

Almeida

Gonçalves

et al. 2019

Int J Reprod Contracept Obstet Gynecol

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Background: Cervical incompetence occasionally results in mid-trimester pregnancy loss, preterm labour and increased foetal morbimortality. History-indicated cerclage is proposed when obstetric history suggests cervical incompetence. The aim of this study was to evaluate the maternal-foetal outcomes following prophylactic cervical cerclage.Methods: Retrospective study reviewing data of all women undergoing transvaginal history-indicated cerclage from January 1st, 2008 to December 31th, 2017 at Centro Hospitalar Universitário do Algarve - Faro. Primary outcome: gestational age <37weeks at birth. Secondary outcomes: neonatal morbimortality and intensive care unit (NICU) admission and maternal morbidity. Data were analyzed with IBM SPSS Statistics 23.Results: A total of 12 history-indicated cerclages were performed (9 women). At first cerclage, mean maternal age, gestity, parity and live children were 27.6, 2.44, 1.11 and 0.78 (87.7% preterm), respectively. At cerclage placement, mean gestational age and cervical length were 16.1 weeks and 27.5mm. Average hospital admission was 10.7 days. In all cases McDonald technique was performed. Four hospital readmissions occurred for threatened labour. Mean gestational age at cerclage removal was 36.9 weeks (83.3% in ambulatory) and 38.9 at delivery. Average time between cerclage removal and labour was 14.5 days. Spontaneous onset of labour occurred in 75% and vaginal delivery in 83.4%. There were no reports of preterm birth, foetal admission to NICU or maternal complications. Mean number of live children after procedure was 1.58.Conclusions: Prophylactic cervical cerclage seems to improve pregnancy outcome with minimal maternal risks. However, our data suggest over inclusion of women, with unnecessary procedures, emphasizing the importance of re-evaluating inclusion criteria.

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Outcome of pregnancy with history-indicated cervical cerclage insertion in a low-resource setting

Abstract: The limitations of the study notwithstanding, use of history-indicated cervical cerclage in pregnancy resulted in better fetal salvage rate and reduced recurrence of spontaneous miscarriage.

Cited by 3 publications

References 12 publications

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

The Indication for Cervical Cerclage and Pregnancy Outcome in a Teritiary Hospital in South-South Nigeria: A Five Year Review

History-indicated transvaginal cerclage: results from a single-centre

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