Prophylactic cervical cerclage for cervical insufficiency

Lo, Pei-Fen; Lin, Yulan; Chang, Wen-Hsun; Wang, Peng-Hui

doi:10.1016/j.tjog.2020.03.030

“…If the gestational week is too late, the uterus is significantly enlarged, the uterine body rises into the abdominal cavity, and the cervix is elevated and shortened, which increases the risk of surgery and may cause premature rupture of membranes or contractions [ 16 ]. It has been reported [ 17 ] that the use of prophylactic cervical cerclage (i.e., treatment with cervical cerclage at 14 to 18 weeks of pregnancy) significantly improves the success rate of the procedure and can effectively reduce intraoperative bleeding and shorten the length of hospital stay. Using this as the cut-off value, the early group was drawn from 14 to 18 weeks of gestation, and the middle group was drawn from 19 to 27 weeks of gestation in this study.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Timing of Cervical Cerclage Treatment in Pregnant Women with Cervical Insufficiency and the Effect on Pregnancy Outcome

He

¹

,

Zhao

²

2022

Emergency Medicine International

3

0

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Purpose. To analyze the effect of the choice of timing of cervical cerclage treatment on pregnancy outcome in pregnant women with cervical insufficiency (CI). Methods. The case data of 160 pregnant women admitted to our hospital for cervical cerclage due to CI from January 2020 to September 2021 were sampled. They were divided into the early group (14∼18 weeks of pregnancy, n = 86), the middle group (19∼27 weeks of pregnancy, n = 74) according to the different gestational periods of surgical treatment, and into the elective group (elective operation, n = 71) and the emergency group (emergency operation, n = 89) according to the different timings of surgical treatment. To compare the pregnancy outcomes of the four groups and the effects of different treatment timings on pregnant women and newborns. Results. After the operation, the intrauterine infection rate in the early group was lower (8.14% (7/86)) than that (71.62% (53/74)) in the middle group, and the intrauterine infection rate (18.31% (13/71)) in the elective group was lower (61.80% (55/89)) than that in the emergency group ( P < 0.05 ). After the operation, the late abortion rate in the early group was 8.14% (7/86) lower than 63.51% (47/74) in the middle group, and the late abortion rate in the elective group was 15.49% (11/71) lower than 61.80% (55/89) in the emergency group ( P < 0.05 ). After the operation, the full-term birth rate (82.56% (71/86)) in the early group was higher (21.62% (16/74)) than that in the middle group, and the full-term birth rate (73.24% (52/71)) of the elective group was higher (24.72% (22/89)) than that in the emergency group ( P < 0.05 ). After the operation, there was no significant difference in the preterm birth rate between the early group and the middle group (8.14% vs 14.86%), and between the elective group and the emergency group (11.27% vs 12.36%) ( P > 0.05 ). There was no significant difference in neonatal Apgar scores between the early group and the middle group (7.30 ± 0.98 vs 7.14 ± 0.91) scores, and between the selective group and the emergency group (7.15 ± 0.82 vs 7.07 ± 1.07) scores ( P > 0.05 ). There was no significant difference in gestational week extension time between the early group and the middle group (6.52 ± 1.77 vs 6.99 ± 1.69) days and between the elective group and the emergency group (6.44 ± 1.37 vs 6.82 ± 1.70) days ( P > 0.05 ). The length of hospital stay was (7.28 ± 1.39 vs 10.89 ± 2.65) days in the early group and the middle group, with the early group being shorter than the middle group ( P < 0.05 ), and the length of hospital stay was (8.72 ± 1.23 vs 9.30 ± 1.39) days in the elective group and the emergency group, with the elective group being shorter than the emergency group ( P < 0.05 ). Conclusions. The therapeutic effect and pregnancy outcome of cervical cerclage are affected by the timing of treatment. Among them, the effect of elective operation at 14∼18 weeks of pregnancy is more ideal, which is worthy of clinical promotion.

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“…5 To produce a successful IOL, cervical ripening is an important first step, followed by appropriate and forceful uterine contractions with a regular frequency which is one of the critical factors seen in preterm labor. 6,7 Based on the guidelines and treatment protocol, cervical ripening can be achieved by mechanical methods and pharmacological methods. Pharmacological agents such as prostaglandins, progesterone receptor antagonists, oxytocin, and nitric oxide are routinely used.…”

Section: Introductionmentioning

confidence: 99%

Assessing the safety and efficacy of dinoprostone vaginal insert in pregnancy

Manickavasagam,

Ramalakshmi

et al. 2023

Int J Reprod Contracept Obstet Gynecol

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Background: Induction of labor (IOL) is a procedure used to achieve vaginal birth when the hazards of extending the pregnancy for either the mother or the infant outweigh the dangers of delivery. It is often used in high-risk pregnancies, although it can also be useful in low-risk groups, as demonstrated by A Randomized Trial of Induction Versus Expectant Management (ARRIVE) study. Methods: The cross-sectional study was conducted among 414 patients at Department of Obstetrics and Gynaecology tertiary care hospital. The study was conducted for one-year duration in pregnant women with maternal age >18 years, gestational week >37 weeks, and Bishop score <7 was included in the study with no signs of labor. Demographic details such as age, pregnancy history, and mode of delivery were recorded for comparison. Patients with no induction of labor were administered misoprostol and/or dinoprostone based on clinical conditions with further evaluation of maternal complications, delivery time, birthweight of the fetus, and fetal heart rate. Data were analyzed based on percentages and a chi-square test was used (p-value <0.05). Results: The mode of delivery did not significantly affect delivery outcomes (p=0.354), with assisted delivery being the most common (35.41%). Indication for induction was found to be significant (p=0.034), with non-progress of labor being the most common indication (55.2%). Maternal complications were not significantly associated with delivery outcomes (p=0.390), with 60 (14.49%) patients experiencing complications. The use of misoprostol reported a significant difference between modes of delivery with 74.93% of vaginal delivery, 19.47% with lower segment cesarean section (LSCS), and 5.60% with assisted delivery (p value <0.03). Conclusions: In low-risk pregnant women, the dinoprostone or misoprostol vaginal inserts are both safe and effective for inducing labor. Nulliparous individuals and those who did not get epidural analgesia during labor had a higher chance of caesarean section.

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