Preterm Deliveries among Women with MacDonald Cerclage Performed due to Cervical Incompetence

Abstract

Objective: The study was aimed to assess the impact of obstetric risk factors for preterm delivery among women with MacDonald cerclage performed due to cervical incompetence. Study Design: A cohort study was conducted including all patients with MacDonald cerclage performed at 12–14 weeks gestation due to cervical incompetence (n = 793). Deliveries occurred between the years 1988 and 2002 in a University Medical Center. A multiple linear regression model was used to assess the impact of maternal characteristics as well as pregnancy complications on the length of pregnancy. Results: The following factors were found to be associated with preterm delivery among these patients, in the univariate analysis: nulliparity, fertility treatments, severe preeclampsia, second-trimester bleeding, premature rupture of membranes (PROM), chorioamnionitis and placental abruption. Using a multiple linear regression model, with backward elimination, the impact of these variables on the length of pregnancy was assessed (R² = 0.33, p < 0.001). The mean gestational age at birth among patients without risk factors was 38.1. Second-trimester bleeding reduced gestational age by 6.4 weeks, chorioamnionitis by 5.6 weeks, placental abruption by 5.1 weeks, PROM by 3.2 weeks and severe preeclampsia by 2.4 weeks. Conclusions: Second-trimester bleeding, chorioamnionitis, placental abruption, PROM and severe preeclampsia are ominous signs for preterm delivery among patients with MacDonald cerclage performed due to cervical incompetence.

Primiparity at Very Advanced Maternal Age (≥45 years)

“…Study women suffered pregnancy complications at rates steeply higher than those in the general population (27,39,41,42), and almost half were hospitalized. The woman also had sevenfold the GDM rate reported by Chodick et al (42).…”

Conservative management of uterine adenosarcoma: lessons learned from 20 years of follow-up

“…Another consideration is whether the placental abruption which resulted in the premature birth of the woman’s twins was related to the follow-up regimen. Placental abruption has been reported to be more likely in cervical cerclage [21], multiple gestation pregnancies and following assisted conception [22], all of which were present in this case. Furthermore, placental abruption has been suggested to occur following damage to the endometrial lining after curettage which may result in abnormal placentation [23].…”

Occurrence of Septic Shock in a Patient Submitted to Emergency Cerclage following a Negative Amniocentesis: Report of a Case

“…On the contrary, the IL-6 levels, despite being increased and compatible with inflammation [12] as well as impending delivery [7], were below the threshold value which has shown a high positive predictive value for intra-amniotic infection [10]. Unfortunately, further rapid tests to assess more accurately the presence of intra-amniotic inflammation were not available in the laboratory of our institution, as well as molecular microbiologic techniques (i.e.…”

“…Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported [4]. Exclusion of intrauterine infection by performing an amniocentesis has been proposed in some studies [5,6,7]. …”