A retrospective review of pregnancy outcomes in patients who had a cervical cerclage at Chris Hani Baragwanath academic hospital between January 2013 and December 2014

Abstract

Preterm delivery is an important cause of neonatal morbidity and mortality worldwide. It has been shown in some studies that compared with no treatment, cervical cerclage reduces the incidence of preterm delivery in women at risk of recurrent preterm delivery, but with no significant reduction in perinatal mortality or neonatal morbidity. The main issues regarding the use of cervical cerclage include patient selection, timing and method of insertion. A retrospective review of hospital records of patients who had a cervical cerclage inserted between 01 January 2013 and 31 December 2014, at Chris Hani Baragwanath Academic Hospital, was conducted. A total of 142 patients were included in the study. A history of two or few spontaneous second trimester miscarriages were found in 72% of patients who had a cerclage inserted. The mean gestational age at insertion of cerclage and removal was 16±5.8 and 34.3±4.2 weeks, respectively. Just over a half, 53%, of the cerclages were done by junior staff. Delivery after 34 weeks gestation occurred in 67.6 % (n=96) of patients and the mean gestational age at delivery was 35.3±4.8 weeks. No significant association was found between the surgeon’s experience and pregnancy outcomes. The majority of patients might have been overtreated owing to the fact that only a third of patients had a history of three or more spontaneous second trimester miscarriages. More than half of the women had one or more live children born at term, suggesting that cervical insufficiency might be an acquired condition. Delivery after 38 weeks was found in half of the patients, reflecting less stringent selection and criteria for cerclage insertion. Larger studies are needed to evaluate findings from this study.