“PREGNANCY OUTCOME IN CERVICAL INCOMPETENCE: COMPARISON OF COMBINED USE OF CERCLAGE AND ORAL PROGESTERONE VERSES HIGH DOSE OF VAGINAL PROGESTERONE”

2021 ◽  
pp. 150-153
Author(s):  
Preeti Gupta ◽  
Uma Jain ◽  
Jayshree Chimrani
Keyword(s):  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Maternity Hospital ◽  
Cervical Length ◽  
High Dose ◽  
Spontaneous Preterm Birth ◽  
Cervical Cerclage ◽  
Cervical Incompetence ◽  
Vaginal Progesterone ◽  
Progesterone Supplementation

INTRODUCTION- Cervical insufciency, earlier known as cervical incompetence, is the inability of the cervix to maintain pregnancy till term due to structural or functional defects. Approximately 16.25% of second-trimester pregnancy losses and 2% of premature deliveries are due to cervical incompetence. OBJECTIVE- The purpose of this study was to compare the outcome of pregnancy in patients who underwent early (12-16 weeks) cervical cerclage along with oral progesterone supplementation versus those having remedied with high dose intravaginal progesterone supplementation. MATERIAL AND METHODst This retrospective study was conducted in a maternity hospital in Gwalior from 1 January 2018 to th 30 June 2021. Comprehensive history, thorough clinical examination, laboratory investigations, ultrasonography measurement of cervical length, mode of delivery, gestational age at the time of delivery, neonatal outcome, NICU admission, and other parameters were collected from the medical les. patients were divided into two groups. Ÿ Group 1(N-49) – Those who were remedied with high-dose vaginal progesterone supplementation continued uptil 34 wks of gestation. Group 2 (N-49) – Those who underwent Mc Donald type of cervical encerclage at 12-16 weeks along with oral progesterone (10 mg Duphaston twice daily dose) supplementation continued up till 34 weeks of gestation. RESULT- In our study, in the cervical cerclage group, only (4.1%) patients were delivered before 34 weeks while in the vaginal progesterone group (18.4%) patients were delivered before 34 weeks. In the cervical cerclage group (53.1%) patients were delivered between 34-37 weeks while in the vaginal progesterone group, (44.9%) of the patient delivered between 34-37 weeks. In the cervical cerclage group, the cesarean section rate was lower than only the vaginal progesterone group and admission to NICU of babies was also less (22.4%) in this group in comparison to the vaginal progesterone only group (36.7%). CONCLUSION- Our study showed that cervical cerclage plus oral progesterone supplementation in women with extremely shortened cervix signicantly decreased overall spontaneous preterm birth rates, prolonged pregnancy latency, and decreased the overall neonatal morbidity and mortality and is more effective than the vaginal progesterone group.

scholarly journals Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History

2016 ◽  
Vol 129 (22) ◽  
pp. 2670-2675 ◽  
Author(s):  
Shao-Wei Wang ◽  
Lin-Lin Ma ◽  
Shuai Huang ◽  
Lin Liang ◽  
Jun-Rong Zhang
Keyword(s):  
Preterm Birth ◽  
Cervical Cerclage ◽  
Birth History ◽  
Cervical Incompetence ◽  
Vaginal Progesterone

scholarly journals Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

2012 ◽  
Vol 8 (3) ◽  
pp. 321-324
Author(s):  
S R Tamrakur ◽  
C D Chawla
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Cervical Length ◽  
University Teaching ◽  
Third Trimester ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Cervical Incompetence ◽  
History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district.  All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation.  33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases.  All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24 

scholarly journals RESCUE CERVICAL CERCLAGE WITH VAGINAL PESSARY SUPPORT AND ALTERNATIVE TOCOLYTICS IN CORONA POSITIVE , DCDA TWIN WITH HIGH LEAKING AND 16 WEEKS OF HOSPITALISATION LEADING TO SUCCESSFUL OUTCOME - A CASE REPORT

2021 ◽  
Vol 9 (5) ◽  
pp. 189-192
Author(s):  
Komal Vijaywargiya ◽  
◽  
Namrata Kachhara ◽  
Kalpana Jain ◽  
Aayushi Ruia ◽  
...  
Keyword(s):  
Case Report ◽  
Pregnancy Loss ◽  
Twin Pregnancy ◽  
Preterm Labour ◽  
Cervical Length ◽  
Successful Outcome ◽  
Cervical Cerclage ◽  
Cervical Incompetence ◽  
Trimester Pregnancy ◽  
Vaginal Pessary

A twin gestation invariably leads to a certain extent of cervical length shortening . If this reduction is also associated with gradual dilatation of internal os and various biochemical , mechanical changes in cervical matrix , this can lead to mid trimester pregnancy loss or preterm labour. This is a case report on Dichorionic , Diamniotic twin pregnancy with cervical incompetence in which rescue cerclage was performed along with judicious use of tocolysis and vaginal pessary.

scholarly journals Rescue Adjuvant Vaginal Progesterone May Improve Outcomes in Cervical Cerclage Failure

2018 ◽  
Vol 78 (08) ◽  
pp. 785-790 ◽  
Author(s):  
Alina Roman ◽  
Fabricio Da Silva Costa ◽  
Edward Araujo Júnior ◽  
Penelope Sheehan
Keyword(s):  
Transvaginal Ultrasound ◽  
Prospective Trial ◽  
Intervention Group ◽  
Clinical Pathology ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Retrospective Case ◽  
Cervical Cerclage ◽  
Vaginal Progesterone ◽  
Length Measurements

Abstract Introduction Aim of the study was to evaluate the effect of rescue adjuvant vaginal progesterone in women with ongoing, transvaginal ultrasound (TVUS)-confirmed cervical shortening despite cervical cerclage. Materials and Methods A retrospective case control study was performed of women undergoing cervical surveillance following either history- or ultrasound-indicated cervical cerclage. We compared women managed with cervical cerclage and vaginal progesterone to women managed with cervical cerclage alone. Women with a singleton pregnancy who underwent cervical cerclage were identified from a database. Data on the concurrent use of vaginal progesterone, cervical length measurements, interventions and birth outcomes were collected from patient notes and clinical pathology notes. Patients from each intervention group were matched, based on exact shortest cervical length measurements obtained during surveillance and age of gestation when the measurement was obtained. Results 66 women were matched and included in the study, based on exact shortest cervical length measurements. Each group had an identical mean shortest cervical length of 12.09 mm. The outcomes of 33 women who received both cervical cerclage and vaginal progesterone were compared to the outcomes of 33 women who were treated with cervical cerclage alone. The administration of vaginal progesterone to women with ongoing cervical shortening despite cervical cerclage was found to significantly prolong the pregnancy (36.36 weeks vs. 32.63 weeks; p = 0.0036) compared to women treated with cerclage alone. This use of rescue adjuvant vaginal progesterone was also associated with higher birth weights (2829 g vs. 2134 g; p = 0.0065) compared to women who had cervical cerclage alone; however, there was no difference in Apgar scores, composite neonatal morbidity or neonatal intensive care admission. Conclusion Women with cervical shortening despite the presence of cervical cerclage may benefit from further TVUS cervical length surveillance and the administration of vaginal progesterone if further cervical shortening occurs. Despite both groups having clinically significant shortened cervical lengths and cervical cerclage in situ, adjunct vaginal progesterone treatment resulted in older gestational age at birth and higher birth weight. Further investigation and confirmation of this finding in a larger prospective trial is warranted to explore this potential benefit for the management of preterm birth in future.

scholarly journals Transvaginal Ultrasound-indicated Cervical Cerclage Versus Vaginal Progesterone in Singleton Women with a Short Cervical Length: A Retrospective Study

2021 ◽  
Author(s):  
Yijun Liu ◽  
Tiantian Cao ◽  
Shuai Zeng ◽  
Ruixin Chen ◽  
Xinghui Liu ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Transvaginal Ultrasound ◽  
Latency Period ◽  
Preterm Births ◽  
Cervical Length ◽  
Secondary Outcome ◽  
Cervical Cerclage ◽  
Primary Methods ◽  
Vaginal Progesterone ◽  
Singleton Pregnancies

Abstract Introduction: Cervical cerclage and vaginal progesterone are two primary methods for preventing preterm birth. However, their effectiveness in preventing singleton pregnancies with a short cervical length is unclear. We compared the effects of cervical cerclage and vaginal progesterone on the mother and neonate in asymptomatic singleton pregnancies in women with a cervical length between 10–30 mm.Material and Methods: Asymptomatic singleton pregnant women with a cervical length of 10–30 mm, measured using transvaginal ultrasound at 12–26 weeks of gestation, who delivered at our hospital were enrolled. The primary outcome measure was preterm birth at <37, 34, 32, and 28 weeks of gestation. The secondary outcome measures were neonatal mortality, latency period from diagnosis to delivery, hemorrhage during delivery, birth weight, and cesarean delivery.Results: In the unadjusted analysis, the number of preterm births was significantly higher in the cerclage group than in the vaginal progesterone group. After multivariate adjustment for confounding factors, this relationship narrowed. The latency period from diagnosis to delivery was significantly prolonged.Conclusions: Cervical cerclage showed no benefit over vaginal progesterone in preventing preterm birth. However, it prolonged gestational age by 39 days compared to vaginal progesterone treatment.

scholarly journals Vaginal progesterone for prevention of preterm birth in asymptomatic high-risk women with a normal cervical length: a systematic review and meta-analysis protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kimberley P. Williams ◽  
Liam McAuliffe ◽  
Rosanna Diacci ◽  
Anne-Marie Aubin ◽  
Ashad Issah ◽  
...  
Keyword(s):  
Preterm Birth ◽  
High Risk ◽  
Meta Analysis ◽  
Cervical Length ◽  
Analysis Model ◽  
Spontaneous Preterm Birth ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
High Risk Women ◽  
Vaginal Progesterone

Abstract Background Preterm birth (PTB) is estimated to affect 14.9 million babies globally every year. Global rates of PTB continue to increase from 9.8 to 10.6% over a 15-year period from 2000 to 2014. Vaginal progesterone is commonly used by clinicians as a prevention strategy, with recent evidence affirming the benefit of vaginal (micronised) progesterone to prevent PTB in women with a shortened cervix (< 25 mm). Given the low incidence of a short cervix at mid-gestation in high-risk populations further evidence is required. The objective of this review is to determine if vaginal progesterone reduces spontaneous preterm birth (sPTB) before 37 weeks in asymptomatic high-risk women with a singleton pregnancy with a normal mid-gestation cervical length. Methods Studies will be sourced from MEDLINE, Embase and Cochrane Register of Trials (CENTRAL) from their inception onwards with the search terms ‘progesterone’ and ‘preterm birth’. Studies will be screened and included if they assess vaginal progesterone compared to placebo in women with a normal cervical length. The primary outcome will be sPTB < 37 weeks, with secondary outcomes of sPTB < 34 weeks. Two independent reviewers will conduct study screening at abstract and full text level, data extraction and risk of bias assessment with disagreements resolved by an experienced researcher. The Mantel-Haenszel statistical method and random effects analysis model will be used to produce treatment effect odds ratios and corresponding 95% confidence intervals. Discussion This review will assess the current body of evidence and provide clarity regarding the potential benefits and best practice of use of vaginal progesterone in asymptomatic women with high-risk singleton pregnancies and normal cervical length. Trial registration PROSPERO CRD42020152051

Sign in / Sign up

Export Citation Format

Share Document