Pregnancy Outcomes of Cervical Cerclage in a Tertiary Care Centre: A Retrospective Study.

backgroundCervical insufficiency is an important cause of recurrent second-trimester pregnancy loss and spontaneous preterm delivery. Cervical cerclage is a surgery done to strengthen the cervix to prolong the pregnancy in women who need it. The result of a cerclage can vary based on the obstetric history, gestational age at the time of the cerclage, cervical length, pregnancy type, and timing of the removal.

aimTo compare the obstetric and demographic features, timing of cervical cerclage, gestational age at delivery, and maternal and neonatal outcomes of women who underwent cervical cerclage at a tertiary-care centre. MATERIAL AND

methodsThe study was a record-based observational study conducted in the Department of Obstetrics and Gynaecology, Government Medical College Jammu, in a retrospective manner. A review of the medical records was performed for 150 pregnant women who had undergone either history-indicated cervical cerclage, ultrasound-indicated cervical cerclage, or emergency cervical cerclage. A structured proforma was used to gather information about demographic data, previous obstetric history, gestational age at cerclage placement, pre-procedure cervical length, timing of cerclage removal, gestational age at delivery, birth outcome, birth weight, neonatal intensive care unit admission, and neonatal mortality. The categorical data were presented in frequencies and percentages. The Pearson chi-square goodness-of-fit test was used, and a p-value less than 0.05 was deemed to be statistically significant.

resultsThe majority of participants were aged 31-40 years, accounting for 94 (62.7%) women. Most were nulliparous, 85 (56.7%), and 78 (52.0%) belonged to the middle socioeconomic group. A total of 95 (63.3%) women had experienced three or more previous abortions, while 48 (32.0%) had undergone cervical cerclage previously. Cerclage was performed at 14-17 weeks of gestation in 79 (52.7%) women, and 78 (52.0%) had a pre-procedure cervical length of more than 15 mm and up to 25 mm. Twin pregnancies accounted for 39 (26.0%) cases. Cerclage removal was performed between 36 and 37 weeks in 98 (65.3%) women. Delivery after 37 weeks occurred in 93 (62.0%) women, while 128 (85.3%) delivered at or beyond 34 weeks. The live-birth rate was 88.0% (132), NICU admission was required in 28 (18.7%) pregnancies, and neonatal mortality occurred in 6 (4.0%). Normal birth weight above 2.5 kg was recorded in 116 (77.3%) newborns. The distributions of the major study variables were statistically significant (p<0.05).

conclusionIn most women, cervical cerclage correlated with good pregnancy and foetal outcomes. Most pregnancies were prolonged beyond 34 weeks and live-birth and neonatal survival rates were high. Proper timing of cerclage and patient selection could help to achieve better perinatal outcomes.