A Five-Year Survey of Cervical Cerclage at a Nigerian Tertiary Hospital

Abstract

N Adewole, AD Isah, O Okochi

Background: Cervical incompetence is an important cause of mid-trimester miscarriage. Mid- trimester pregnancy loss is a distressing event for both parents and physician contributing significantly to perinatal mortality, hence Cervical Cerclage. Proper definition of cervical incompetence and proper patient selection will improve the outcome of cervical cerclage.

Objective: To document the indications, outcome and complications associated for cervical cerclage insertion

Methods and Material: A 5-year retrospective analysis undertaken on patients who had cervical cerclage for cervical incompetence at the university of Abuja teaching hospital, Gwagwalada FCT within the period spanning from January 2012 to December 2017. Case folders of patients who had cervical cerclage were retrieved from the central records.

Results: In this study, 96 patients had cervical cerclage. Women within the age range of 26-30 (42.7%) had the highest cerclage insertion. Most of the cerclage were done between 14-16 weeks’ gestation (45.8%) while, 38 (39.6%) were done below 14weeks and 14 (14.6%) were done above 16weeks gestation. All patients had McDonald’s stitch. The most predominant indication for cerclage insertion being “history indicated” (78.1%). The most observed complication was pre-term labour 16 (16.7%) while majority of the patients 53 (55.2%) had no complications. The hallmark of the study was, out of the 96 women who had cervical cerclage, 14 (14.6%) had miscarriage and 82 (85.4%) delivered above the age of fetal viability. Out of the 82 patients that delivered above viability, 69 (84.1%) term deliveries, 13 (15.9%) preterm deliveries. Out of the 82 deliveries above fetal viability, there were 76 (92.7%) live births and 6 (7.3%) stillbirths. Vaginal deliveries were 61 (74.4%), while 21 (25.6%) were caesarean section. Therefore 69 (71.9%) of patients within this study had a successful cerclage.

Conclusion: Cervical cerclage remains one of the most practiced and deemed effective methods of preventing and prolonging preterm births. Its outcome depends on a careful patient selection and procedure.

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