Routine Cervical Cerclage in Higher Order Multiple Gestation — Does It Prolong the Pregnancy?

Twin Research ◽  
2002 ◽  
Vol 5 (2) ◽  
pp. 67-70 ◽  
Author(s):  
Alexander Strauss ◽  
Ivo M. Heer ◽  
Udo Janßen ◽  
Christian Dannecker ◽  
Peter Hillemanns ◽  
...  
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Positive Impact ◽  
Multiple Pregnancy ◽  
Medical Intervention ◽  
Multiple Gestation ◽  
Perinatal Morbidity ◽  
Cervical Cerclage ◽  
Significant Difference ◽  
Prophylactic Cerclage

AbstractPreterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher’s exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the “no cerclage-triplets”, while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.

scholarly journals Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India

2018 ◽  
Vol 7 (6) ◽  
pp. 2455
Author(s):  
Shivali Bhalla ◽  
Seema Grover Bhatti ◽  
Shalini Devgan
Keyword(s):  
Gestational Age ◽  
Perinatal Outcome ◽  
Twin Pregnancy ◽  
Tertiary Care ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
North India ◽  
Care Hospital ◽  
Perinatal Morbidity

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.

Diagnostic Accuracy of Doppler Ultrasound in Predicting Perinatal Outcome in Appropriate for Gestational Age Fetuses: A Prospective Study

2020 ◽  
Author(s):  
Danilo Buca ◽  
Giuseppe Rizzo ◽  
Sarah Gustapane ◽  
Ilenia Mappa ◽  
Martina Leombroni ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prospective Study ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Primary Outcome ◽  
Adverse Outcome ◽  
Perinatal Morbidity ◽  
Acid Base ◽  
Appropriate For Gestational Age ◽  
Acid Base Status

Abstract Objective To elucidate the role of Doppler ultrasound in predicting perinatal outcome in appropriate for gestational age (AGA) fetuses at term. Material and Methods Prospective study carried out in a dedicated research ultrasound clinic. The inclusion criterion was AGA fetuses, defined as those with an estimated fetal weight between the 10th and 90th percentile, at 36 + 0–37 + 6 weeks of gestation. The primary outcome was a composite score of adverse perinatal outcome including either adverse intrapartum events or abnormal acid-base status at birth. Secondary outcomes were the individual components of the primary outcome. The Doppler parameters explored were umbilical artery (UA) PI, middle cerebral artery (MCA) PI, uterine arteries (UtA) PI and cerebroplacental ratio (CPR). Attending clinicians were blinded to Doppler findings. Logistic regression and ROC curve analyses were used to analyze the data. Results 553 AGA fetuses were included. There was no difference in mean UA PI (p = 0.486), MCA PI (p = 0.621), CPR (p = 0.832) and UtA PI (p = 0.611) between pregnancies complicated by composite perinatal morbidity compared to those not complicated by composite perinatal morbidity. In pregnancies complicated by adverse intrapartum outcome, the mean MCA PI (1.47 ± 0.4 vs 1.61 ± 0.4, p = 0.0039) was lower compared to the control group, while there was no difference in UA PI (p = 0.758), CPR (p = 0.108), and UtA PI (p = 0.177). Finally, there was no difference in any of the Doppler parameters explored between AGA fetuses with abnormal acid-base status at birth compared to those without abnormal acid-base status at birth. In the logistic regression analysis, UA PI, MCA PI, CPR, UtA PI, EFW and AC percentiles were not independently associated with composite adverse outcome, adverse intrapartum outcome or abnormal acid-base status at birth in non-SGA fetuses. The diagnostic performance of all of these Doppler parameters for predicting composite adverse outcome, adverse intrapartum outcome and abnormal acid-base status was poor. Conclusion Cerebroplacental and maternal Doppler is not associated with or predictive of adverse pregnancy outcome in AGA fetuses close to term.

scholarly journals Effect of oral L- arginine versus intravenous hydration on maternal and fetal outcome in idiopathic oligohydramnios

2021 ◽  
Vol 10 (5) ◽  
pp. 1943
Author(s):  
Suhail Iqbal ◽  
Mehak Ayub Malik ◽  
Heena Kaurani ◽  
Divya Chauhan
Keyword(s):  
Risk Factors ◽  
Amniotic Fluid ◽  
Gestational Age ◽  
Perinatal Outcome ◽  
Normal Growth ◽  
Fetal Outcome ◽  
Perinatal Morbidity ◽  
Inclusion Criteria ◽  
Amniotic Fluid Index ◽  
Intravenous Hydration

Background: Adequate amount of amniotic fluid was required for normal growth of fetus. Oligohydramnios or reduced amount of amniotic fluid is associated with adverse maternal and perinatal outcome due to increase in induced labour and operative deliveries. Idiopathic oligohydramnios is a condition in which no other risk factors are associated with pregnancy. This study was done to compare the effect of L-arginine and IV hydration on improvement of amniotic fluid index and fetal growth.Methods: Total 50 patients were included in the study according to inclusion criteria and divided equally into two groups randomly. IV hydration was given to one group and other group received L- arginine sachet orally. The effect on AFI and fetal outcome was compared.Result: The result was compared with respect to age, gravidity, gestational age and AFI at the time of study and after giving treatment. Maternal and fetal outcome was compared which shows that L-arginine was more effective in increasing the AFI and thereby leading to favorable results in the form of increase in gestational age at time of delivery and fetal weight.Conclusion: This study shows that both IV hydration and L-arginine are useful in treatment of oligohydramnios. But L-arginine appears more advantageous over IV hydration in improving pregnancy outcome and reducing perinatal morbidity and mortality.

Antenatal Azithromycin to Prevent Preterm Birth in Pregnant women with Vaginal Cerclage. A Randomized Controlled Trial

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Rania Hassan Mostafa ◽  
Sherif Ahmed Ashoush ◽  
Hassan Awwad Bayoumy ◽  
Wessam Kamal Lotfy Gabr
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Antenatal Care ◽  
Gestational Age ◽  
Mode Of Delivery ◽  
Perinatal Morbidity ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Gestational Age At Delivery

Abstract Background Preterm birth with its complications is one of the leading causes of perinatal morbidity and mortality, as well as maternal morbidity, especially in low and middle-income countries. Cervical cerclage is a well-established preventive tool in women at high risk of preterm birth; however, subclinical maternal infection might still cause failure of this method. Thus, adding prophylactic antibiotics, namely macrolides, could prevent preterm birth. Patients and methods This was a randomized controlled clinical trial involving two groups of women who underwent vaginal cerclage at Ain Shams University Maternity Hospital. One group received azithromycin 500mg one tablet orally once daily for 3 days every month from 14th week to 34th week gestation, in addition to routine antenatal care; while the other group received usual antenatal care without antibiotic prophylaxis after cerclage. Follow-up was done and we compared the outcomes in each group: gestational age at delivery, birth weight, mode of delivery, maternal complications, and perinatal complications. ClinicalTrials.gov Identifier NCT04278937. Results Gestational age at delivery was significantly higher in the azithromycin group (36.8weeks vs 34.1weeks; P = 0.017), with significant prolongation of gestation in the azithromycin group (23.7weeks vs 21.1weeks; P = 0.005). As regards birth weight, it was significantly higher in the azithromycin group (2932.6gm vs 2401.8gm; P = 0.006); however babies with low birth weight (birth weight <2500gm) were non-significantly less frequent in the azithromycin group (3cases vs 7cases; P = 0.165). There was no significant difference between the two groups as regards other outcomes (miscarriage, stillbirth, neonatal intensive care unit admission, antepartum hemorrhage, postpartum pyrexia, need for blood transfusion). Conclusion Adding azithromycin as antenatal prophylaxis in women undergoing vaginal cerclage prolongs pregnancy and reduces risk of PTB, with slight increase in birth weight. However, there was no clear effect on incidence of low birth weight, or perinatal morbidity/mortality.

scholarly journals Pregnancy complications in COVID-19 positive primigravid patients: a comparative study

2020 ◽  
pp. 71-73
Author(s):  
Rushdana Rahman ◽  
Faryal Mustary
Keyword(s):  
Respiratory Distress ◽  
Pregnant Women ◽  
Gestational Age ◽  
Pregnancy Complications ◽  
Metabolic Diseases ◽  
Mode Of Delivery ◽  
Multiple Pregnancy ◽  
Normal Vaginal Delivery ◽  
College Hospital ◽  
Significant Difference

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new strain of corona virus causing COVID-19. Previous studies suggested that COVID-19 is more likely to affect older males with co-morbidities. But pregnant women are at greater risk of exposure to SARS-CoV-2 infection due to physiological and immunological changes during pregnancy. This study aimed to monitor the pregnancy complications and mode of delivery. Methods: This prospective observational study was carried out in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka over from May 2020 to July 2020. A total of 20 primigravid singleton pregnant women of all trimesters having COVID-19 positive reports (mild to moderate) were included in this study. Similar numbers of primigravid singleton pregnant women of all trimester having negative COVID-19 report were included in this study. Women having age between 18 and 40 years were included. Patients with multiple pregnancy, pregnancy with hypertension, heart disease, renal disease and other metabolic diseases were excluded from this study. Results: Most of the patients were between 26 and 35 years old. Mean age was 29.25 ± 4.42 years in COVID positive group and 31.10 ± 4.65 years in COVID negative group. In positive cases, most of them had gestational age below 37 weeks but in negative cases, most of them had gestational age e•37 weeks. There was significant difference in gestational age between two groups. Regarding type of delivery, in positive cases most underwent Caesarean section and in negative cases maximum were normal vaginal delivery. Regarding antenatal complication during pregnancy, abortion, premature rupture of membrane and pre term labour was found significantly higher in positive cases than that of negative cases. Respiratory distress and psychological upset were observed significantly higher in positive cases than that of negative cases. Conclusion: Regarding antenatal complications and mode of delivery, Frequency of abortion, PROM, preterm labor and LUCS was significantly higher in COVID-19 cases. Respiratory distress and psychological upset was significantly higher in COVID-19 positive cases. COVID-19 Among postnatal complications infection might increase the risk of pregnancy complications and pregnant women could have a severe clinical course of the disease. Birdem Med J 2020; 10, COVID Supplement: 71-73

scholarly journals The effects of cervical cerclage practice on perinatal and neonatal outcomes according to the indications

2020 ◽  
Vol 28 (3) ◽  
pp. 164-169
Author(s):  
Serdar Kaya ◽  
Fatma Ceren Güner ◽  
Mehmet Şimşek ◽  
Selahattin Kumru
Keyword(s):  
Preterm Labor ◽  
Previous History ◽  
Cervical Length ◽  
Neonatal Outcomes ◽  
Cervical Insufficiency ◽  
Singleton Pregnancy ◽  
Cervical Cerclage ◽  
Significant Difference ◽  
Prophylactic Cerclage ◽  
The Mean

Objective: The aim was to investigate the perinatal and neonatal outcomes in the cases which underwent cervical cerclage, and to compare the elective and emergency cerclage cases. Methods: The cases that underwent cervical cerclage in the Hospital of the Faculty of Medicine at Akdeniz University between January 2014 and December 2019 were assessed retrospectively, and separated into 3 categories as the prophylactic, elective and emergency groups. The demographic characteristics and perinatal and neonatal outcomes were recorded and they were compared between the groups. Results: A total of 92 cases with singleton pregnancy between 12 and 24 weeks of gestation were included in the study. The prophylactic cerclage group consisted of 48 cases, the elective cerclage group consisted of 21 cases and the emergency cerclage group consisted of 23 cases. The rate of the cases delivered at term (≥37 weeks of gestation) was found significantly lower in the emergency cerclage group than the rates of the cases in the prophylactic and elective cerclage groups (26.1%, 70.8% and 66.7%; respectively). While there was no significant difference between the prophylactic and elective cerclage groups in terms of premature preterm labor (<32 weeks of gestation), the rate of premature preterm labor was significantly higher in the emergency cerclage group than two other groups (10.4%, 9.5% and 43.5%, respectively; p=0.005). The mean delivery week of the emergency cerclage cases was significantly higher than the prophylactic and elective cerclage groups (31.7, 36.7 and 36.5 weeks, respectively; p<0.001). The mean duration between the cerclage procedure and the delivery week was the highest in the prophylactic cerclage cases and the lowest in the emergency cerclage cases (22.8 and 9.7 weeks, respectively; p<0.001). The mortality rate of the newborns was higher in the emergency cerclage cases than the other groups, which was statistically significant (p=0.002). Conclusion: We concluded that the perinatal and neonatal outcomes of the emergency cerclage procedure carried out in the advanced stage of cervical changes in the cases with cervical insufficiency is less successful than the prophylactic and elective cerclage procedures. The early detection of cervical insufficiency by the previous history, the physical examination and the measurement of transvaginal cervical length and responding at the early weeks of gestation may improve the perinatal and neonatal outcomes.

TERM BREECH DELIVERY

2005 ◽  
Vol 16 (4) ◽  
pp. 289-322
Author(s):  
ANDREAS HERBST ◽  
KARIN KÄLLÉN
Keyword(s):  
Interim Analysis ◽  
Perinatal Outcome ◽  
Controlled Trial ◽  
Case Control ◽  
Perinatal Morbidity ◽  
Case Control Studies ◽  
Mortality And Morbidity ◽  
Breech Delivery ◽  
Significant Difference ◽  
Randomised Controlled

In October 2000, Hannah et al published a randomised controlled trial comparing perinatal and maternal outcome between planned vaginal and planned caesarean deliveries of term breech pregnancies. The study was closed after an interim analysis, showing a reduced perinatal morbidity and mortality with planned caesarean section. The result was not unexpected, although a trial like this had been called for over many years to resolve the issue. Many cohort- and case-control studies, and two small randomised studies had been performed since 1959, when Wright reported a reduced perinatal mortality and morbidity with CS. A few large registry studies had shown a better perinatal outcome with caesarean delivery, whereas smaller studies often showed no statistically significant difference in outcome, often with the conclusion that vaginal delivery (VD) is safe.

Perinatal Outcome of Twins Compared to Singletons of the Same Gestational Age: A Case-Control Study

2011 ◽  
Vol 14 (1) ◽  
pp. 88-93 ◽  
Author(s):  
Nathalie Petit ◽  
Hendrik Cammu ◽  
Guy Martens ◽  
Emile Papiernik
Keyword(s):  
Neonatal Mortality ◽  
Gestational Age ◽  
Death Rate ◽  
Congenital Malformations ◽  
Perinatal Outcome ◽  
Neonatal Death ◽  
Case Control Study ◽  
Case Control ◽  
Significant Difference ◽  
Control Study

Our objective was to determine the perinatal outcome of first- and second-born twins compared to singletons, born at the same gestational age. To that end we conducted a case-control study in Flanders (Northern Belgium). During a 10-year period (01.01.1999–31.12.2008), the entire twin population — 11,154 first- and 11,118 second-born twins (cases) — was compared to 22,228 singletons (controls) with respect to fetal and neonatal (0–27 days) mortality. Only case and control infants of ≥ 500 grams were included, which explained the unequal number of first- and second-born twins. Mothers and their infants of cases and of controls were derived from the Flemish perinatal database and were matched for maternal age and parity, gestational age and gender of the offspring. The main outcome measures were fetal and neonatal mortality according to gestational age. The frequency of fetal death was statistically significantly less frequent in preterm born twins than in singletons, except at term where the reverse was seen in second-born twins compared to controls. After adjustment for congenital malformations, the results stayed unchanged. Below 28 weeks gestation, singletons had a significantly lower neonatal mortality rate than twins that persisted after adjustment for congenital malformations: the first-born twin versus singleton OR 1.71 (1.17–2.51) and second-born versus singleton OR 2.09 (1.43–3.05). Between 28 and 32 weeks, the second-born twin showed a survival advantage over the control singleton. Between 32 and 36 6/7 weeks both twins had a significantly higher survival rate than the corresponding singleton controls. However, after adjustment for congenital malformations, the aforementioned differences between 28 and 36 6/7 weeks disappeared. When at term, twins and singletons had a comparable, though very low, neonatal death rate. These results confirm previous published data. In conclusion, we demonstrated that the neonatal death rate was lower for twins between 32 and 36 weeks (from 28 weeks for the second born twin) when compared to a singleton of the same gestational age. After adjusting for congenital malformations, there was no statistical significant difference.

scholarly journals Effect of vaginal progesterone in combination with cervical cerclage on improved gestational age and perinatal outcome in twin pregnancy: A prospective randomized study

2017 ◽  
Vol 6 (8) ◽  
pp. 3224 ◽  
Author(s):  
Abdelaal N. ◽  
Sanad Z. ◽  
Shaheen A. ◽  
Hamza H. ◽  
Al Halaby A.
Keyword(s):  
Gestational Age ◽  
Twin Pregnancy ◽  
Statistical Significance ◽  
Randomized Study ◽  
Admission Rate ◽  
University Hospital ◽  
Combination Group ◽  
Cervical Cerclage ◽  
Vaginal Progesterone ◽  
Significant Difference

Background: Prematurity is the second leading cause of death in the first month of life. Objective of present study was to evaluate the effectiveness of vaginal progesterone and cervical cerclage each alone and in combination in improving gestational age in twin pregnancy and its subsequent impact on perinatal outcome.Methods: A sample size of seventy-five patients has been calculated out of those recruited from outpatient clinic at menoufia university hospital. All fulfilled eligibility criteria of having a twin pregnancy with a history of spontaneous preterm labour, or with a sonographic short cervical length <25mm in mid trimester. The participants were randomly assigned to three groups. Group 1 (N-25): received vaginal progesterone supplementation of 200 mg from 20 weeks until 34 weeks of gestation. Group2 (N-25): were remedied with cervical cerclage of Mc Donald type at 14-16 weeks of gestation Group 3 (N-25): received both vaginal progesterone as well as cervical cerclage. The primary outcome measure was spontaneous delivery between 34-37 weeks of gestation. Secondary outcomes were delivery prior 34 weeks of gestation as well as some parameters of neonatal morbidity and mortality.Results: There was a statistically significant higher gestational age in combination group when compared to progesterone group or cerclage group (P<0.001). Comparison between progesterone and cerclage groups did not reach statistical significance(P=-0.85). Both progesterone and cerclage groups demonstrated significantly lower birth weights, lower Apgar scores and a higher NICU admission rate than in combination group(P<0.001), while such significant difference did not exist between progesterone and cerclage groups.Conclusions: Combination of vaginal progesterone and cervical cerclage can improve gestational age at delivery as well as some parameters of perinatal morbidity and mortality in twin pregnancy.

Cotton (Umbilical) Tape as Suture Material for Cervical Cerclage: A Case Series

2010 ◽  
Vol 2 (2) ◽  
pp. 127-128
Author(s):  
Randhir Puri ◽  
MB Bellad ◽  
JC Shravage
Keyword(s):  
Gestational Age ◽  
Suture Material ◽  
Multiple Pregnancy ◽  
Case Series ◽  
Posterior Surface ◽  
Singleton Pregnancy ◽  
Cervical Cerclage ◽  
Fetal Survival ◽  
Term Delivery ◽  
Gestational Age At Delivery

ABSTRACT Introduction The present case series was an attempt to find out cotton (umbilical) tape usefulness as suture material for cervical encerclage as it is presterilized, easily visible and economical. Methods Objective To determine utility of cotton tape as suture material for cervical cerclage. Study design: A case series. Place KLES Hospital and District Hospital, Belgaum. Period 1997 to 2001. Inclusion criteria Singleton pregnancy, gestational age by USG (14-26 weeks), H/o 2nd trimester abortions, H/o Pre-term labor, elective cerclage. Exclusion criteria Medical diseases, multiple pregnancy, emergency encerclage, fetal anomalies by USG, not willing to provide consent. Outcome Gestational age at delivery, fetal survival, morbidity [white discharge per vagina (PV), cervical dystocia, puerperal pyrexia]. Intervention Cerclage with cotton tape. Technique Modified Mc Donald's: The suture is commenced from the posterior surface of the cervix and knot is put in the posterior surface. Results 89.3% (25 women) had term deliveries, i.e. 37 to 40 weeks, 7.1% (2 women) had spontaneous delivery at 36 weeks and one women (3.6%) had pre-term delivery at 30 weeks with the fetal survival was 96.4%. Conclusion The present case series proves that the simple economical cotton (umbilical) tape is effective as a suture material for cervical encerclage. However a larger randomized trial can confirm these findings.

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