Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women

  • Yanyan Liu
  • Zikan Ke
  • Wanmin Liao
  • Hanping Chen
  • Shiqing Wei
  • Xiaoquan Lai
  • Xi Chen
General Gynecology

Abstract

Purpose

To compare the clinical effect of prophylactic cervical cerclage and therapeutic cervical cerclage on pregnancy outcome and operative factors in cervical insufficiency pregnant women.

Methods

A retrospective study was conducted between June 2014 and September 2016 in a maternity ward, which included women who have had a single pregnancy and have been carried out a McDonald cerclage. All maternal medical records were reviewed. The efficacy of cerclage for preventing late foetal loss was assessed using multivariable logistic regression analysis.

Results

The results showed that there were significant associations between cerclage operations and pregnancy outcomes in the duration of pregnancy prolongation in terms of live births, gestation age, live birth and cesarean section rate. In prophylactic cervical cerclage, compared with therapeutic cervical cerclage, cervical length before surgery was significantly longer (32.7 ± 5.8 vs 19.9 ± 7.3 mm, p < 0.0001). Mean operative duration and postoperative length of hospital stay in prophylactic cervical cerclage were shorter than those in therapeutic cervical cerclage (22.1 ± 10.3 vs 28.9 ± 13.0 min, p = 0.0241 and 5.6 ± 1.8 vs 7.0 ± 2.8 days, p = 0.0354), respectively. Compared with therapeutic cerclage, prophylactic cerclage had more advantages in gestational age at delivery (35.2 ± 5.5 and 31.7 ± 6.5 weeks, p = 0.0061), deliveries < 37 gestational weeks (40 vs 69.2%, p = 0.0159), live births (93.3 vs 69.2%, p = 0.0143) and the duration of pregnancy prolongation in terms of live births (19.5 ± 5.0 vs 12.0 ± 8.2 weeks, p = 0.0002). There was a higher cesarean section rate in prophylactic group than that in therapeutic group (50 vs 25.6%, p = 0.0383). The logistic analysis showed that the cervical length before surgery was the only independent prognostic factor [OR 2.860 (1.425, 5.742) p = 0.0031] for pregnancy outcome, and that is the cervical length before surgery affected late foetal loss.

Conclusions

Our study suggests that, both prophylactic cervical cerclage and therapeutic cervical cerclage reduce the incidence of recurrent abortion or preterm birth and efficiently extend the length of the pregnancy with live births. The prophylactic cervical cerclage has more advantages in operative time, length of hospital stay after surgery, gestational age at delivery, live births and preterm birth. The length of the cervical before surgery is an independent risk factor for pregnancy outcomes when pregnant women appear in the cervical shortening is less than normal. Cervical cerclage is an effective surgical technique to prevent recurrent abortion or late foetal loss.

Keywords

Preterm birth Cervical insufficiency Cervical cerclage 

Notes

Acknowledgements

This work was supported by Grant from the National Natural Science Foundation of China (no. 71473098).

Author contributions

YYL: data collection and analysis, manuscript writing. ZKK: data collection, manuscript writing. WML: data collection and analysis. SQW: data analysis. HPC: project designing, manuscript editing. XQL: manuscript editing. XC: project designing, data analysis, manuscript editing. All authors reviewed the report and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors state that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Daskalakis GJ (2009) Prematurity prevention: the role of cerclage. Curr Opin Obstet Gynecol 21:148–152CrossRefPubMedGoogle Scholar
  2. 2.
    Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J (2017) Long-term follow-up after abdominal cerclage: a population-based cohort study. Eur J Obstet Gynecol Reprod Biol 210:207–211CrossRefPubMedGoogle Scholar
  3. 3.
    Brown R, Gagnon R, Delisle MF (2013) Maternal Fetal Medicine Committee. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can 35:1115–1127CrossRefPubMedGoogle Scholar
  4. 4.
    Owen J, Hankins G, Iams JD, Berghella V, Sheffield JS et al (2009) Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 201:375.e1–375.e8CrossRefGoogle Scholar
  5. 5.
    Tran PL, Payet G, Barau G, Boukerrou M (2016) Cervical cerclage in Reunion island: evaluation of physicians’ practice patterns. J Gynecol Obstet Biol Reprod 45(7):731–737CrossRefGoogle Scholar
  6. 6.
    Berghella V, Odibo AO, Tolosa JE (2004) Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: a randomized trial. Am J Obstet Gynecol 191:1311–1317CrossRefPubMedGoogle Scholar
  7. 7.
    Song RK, Cha HH, Shin MY (2016) Post-cerclage ultrasonographic cervical length can predict preterm delivery in elective cervical cerclage patients. Obstet Gynecol Sci 59:17–23CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Gluck O, Mizrachi Y, Ginath S, Bar J, Sagiv R (2017) Obstetrical outcomes of emergency compared with elective cervical cerclage. J Matern Fetal Neonatal Med 30:1650–1654CrossRefPubMedGoogle Scholar
  9. 9.
    Capmas P, Thellier E, Carcopino X, Huchon C, Deffieux X et al (2014) Management of women with a previous late fetal loss (14 to 22 weeks of gestation). J Gynecol Obstet Biol Reprod 43:856–864CrossRefGoogle Scholar
  10. 10.
    Smith J, DeFranco EA (2015) Tocolytics used as adjunctive therapy at the time of cerclage placement: a systematic review. J Perinatol 35:561–565CrossRefPubMedGoogle Scholar
  11. 11.
    Abdel-Aleem H, Shaaban OM, Abdel-Aleem MA (2013) Cervical pessary for preventing preterm birth. Cochrane Database Syst Rev 31:CD007873Google Scholar
  12. 12.
    Suhag A, Berghella V (2014) Cervical cerclage. Clin Obstet Gynecol 57:557–567CrossRefPubMedGoogle Scholar
  13. 13.
    Bayrak M, Gul A, Goynumer G (2017) Rescue cerclage when foetal membranes prolapse into the vagina. J Obstet Gynaecol 37:471–475CrossRefPubMedGoogle Scholar
  14. 14.
    Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J (2016) Recurrence of second trimester miscarriage and extreme preterm delivery at 16-27 weeks of gestation with a focus on cervical insufficiency and prophylactic cerclage. Acta Obstet Gynecol Scand 95:1383–1390CrossRefPubMedGoogle Scholar
  15. 15.
    American College of Obstericians and Gynecologists, ACOG Practice Bulletin (2003) Cervical insufficiency. Obstet Gynecol 102:1091–1099Google Scholar
  16. 16.
    Korb D, Marzouk P, Deu J, Oury JF, Sibony O (2017) Effectiveness of elective cervical cerclage according to obstetric history. J Gynecol Obstet Hum Reprod 46:53–59CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Hospital Infection Control, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  2. 2.Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  3. 3.School of Foreign LanguagesHuazhong University of Science and TechnologyWuhanPeople’s Republic of China
  4. 4.Department of Anesthesia, Tongji Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanPeople’s Republic of China

Personalised recommendations