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

Abstract

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.

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

“…This is relatively similar to findings in previous studies in Nigeria. 25,27 This prolongation may be due to the early insertion of the stitch in this study. The indication for removal of our stitches was pregnancy carried to term in 72.5% of cases.…”

“…The sociodemographic characteristics found in this study are similar to other studies done in the same and other regions of Nigeria with a mean age of 33.3yr ± 3.9yr. [25][26][27] The prevalence of cervical incompetence in this study was about 0.89%. This prevalence is similar to 0.85% reported from the central part of Nigeria.…”

“…Though, this is less than 59.4% found in Port-Harcourt, southeast Nigeria. 27 Both studies agreed with the American College of Obstetricians and Gynecology (ACOG) guidelines that state that history or ultrasound scanning findings as well as rescue cerclage are recommended reasons for cervical cerclage insertion. 22 However, the ultrasound scanning indicated was the highest reason for cervical cerclage in our study accounting for 75%.…”

“…Spinal anesthesia and conscious sedation were administered in equal proportion in this study like in other studies. [27][28][29][30] The duration spent by cervical stitch in situ ranged from 10-20 weeks in 53% of our patients. This is relatively similar to findings in previous studies in Nigeria.…”

“…The former is the preferred choice in other studies reviewed. 20,27,29 However, a study by Feyi-Waboso PA, in Aba, south-eastern Nigeria reported higher use of the Shirodkar technique. 30 Relaxation of the patients and adequate exposure of the vagina are important to successfully apply the tape.…”