Cervical Insufficiency and Cerclage Treatment of Pregnant Syrian Refugees

Objective: We aimed to evaluate the cervical cerclage treatment among the Syrian refugees with cervical insufficiency. Material and Methods: Retrospective data of 42 Syrian pregnant women who had cervical cerclage suture due to cervical insufficiency between 2015 and 2017 scanned and analyzed with SPSS 22. Results: The mean age of the cases included in the study was 27.4±6.8. 12 cases (28.6%) had spontaneous pregnancy losses twice in the 2nd trimester. 24 cases (57.1%) gave birth via spontaneous vaginal delivery, whereas 18 cases (42.9%) gave birth via cesarean section. A statistically significant difference was determined between pre-cerclage and post-cerclage cervical length. Whilst no difference was detected in pre-cerclage cervical length for deliveries at week 37, a significant difference was detected in post-cerclage length. Conclusıon: Increased miscarriages and second-trimester pregnancy losses seen in the first years of the war especially due to the use of chemical weapons and the stress suffered thereafter as well as the increased reproductive interest after the war bring together a greater desire for a healthy pregnancy and delivery. We believe that cervical-length measurement using transvaginal sonography during post-cerclage checks is important and that measurement of a cervical length equal to or above 30 mm may increase the probability of term delivery and decrease maternal, and most importantly, neonatal complications associated with preterm labor.

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

Perinatal Journal ◽

10.2399/prn.20.0283003 ◽

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.

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Cervical sonomorphometric evaluation of normal and preterm labour by transvaginal and transabdominal sonography

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20170042 ◽

2017 ◽

Vol 6 (2) ◽

pp. 417

Author(s):

Khusboo . ◽

Dinesh Kumar ◽

Ashish Verma ◽

Suman Chaurasia ◽

Ramvilas Nag

Keyword(s):

Imaging Modality ◽

Statistical Significance ◽

Cervical Length ◽

Morbidity And Mortality ◽

Transvaginal Sonography ◽

Perinatal Morbidity ◽

Doppler Measurement ◽

Full Bladder ◽

Significant Difference ◽

Patients At Risk

Background: Preterm delivery is major cause of perinatal morbidity and mortality. Measuring cervical length (CL) with ultrasonography has become increasingly acceptable as an early diagnostic procedure in patients at risk for PTL, with transvaginal ultrasonography (TV Us) being considered as the gold standard for the CL assessment.Methods: A cohort of women with singleton pregnancies, and confirmed gestational age by first or early second trimester ultrasonography, last menstrual period & clinical assessment were selected to undergo transvaginal and transabdominal sonographic measurement of cervical length between 16 and 34 week gestation. Cervical length was first measured by transabdominal route (TAS) using a 3.5 MHz curved electronic array transducer with the patient in the supine position and with a full bladder, transvaginal sonography (TVS) was done by a 7.5 MHz probe attached to an ultrasound machine. The probe was covered with a latex condom and gel placed between the transducer and the cover and also on the surface. It was then gently inserted in the vagina to obtain a sagittal view of the cervix. Doppler measurement were taken by both transabdominal and transvaginal route.Results: Gradual decrease in cervical length is seen with advancement of gestation weeks. TA Us cervical length values are noted higher than TV Us however significance is seen only at 24 weeks and cervical width are showing gradual increase with advancement of gestation weeks without significant difference between them. The study compared the mean spectral Doppler parameters RI, PI and S/D Ratio at different weeks & observed that TV Us values are more at each gestation weeks than TA Us showing significant difference 24 weeks onwards.Conclusions: Although discrepancy in statistical significance, short cervical length, funneling and gland area are important to recognize for prediction of premature onset of labour, owing to the potential for perinatal morbidity and mortality and socioeconomic burden. Transvaginal sonography remains the dominant imaging modality for evaluation of the cervix. It is operator dependent modality so care should be taken to evaluate each morphologic character.

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Adjuvant administration of 17-α-hydroxy-progesterone caproate in women with three or more second trimester pregnancy losses undergoing cervical cerclage is no more effective than cerclage alone

Journal of Perinatal Medicine ◽

10.1515/jpm-2017-0074 ◽

2018 ◽

Vol 46 (2) ◽

pp. 155-161 ◽

Cited By ~ 5

Author(s):

Fernand D. Samson ◽

Amanda L. Merriman ◽

Danielle L. Tate ◽

Katherine Apostolakis-Kyrus ◽

Luis M. Gomez

Keyword(s):

Perinatal Outcomes ◽

Cervical Insufficiency ◽

Second Trimester ◽

Trimester Pregnancy ◽

Significant Difference ◽

Gestational Age At Delivery ◽

Adverse Neonatal Outcomes ◽

Second Trimester Pregnancy ◽

Prophylactic Cerclage ◽

Hydroxy Progesterone

AbstractObjective:To investigate the role of adjuvant 17-α-hydroxy-progesterone caproate (17OHP-C) in reducing the risk of preterm delivery <34 weeks and adverse perinatal outcomes in women with ≥3 second trimester pregnancy losses attributed to cervical insufficiency undergoing prophylactic cerclage.Material and methods:Retrospective cohort study of women with prophylactic cerclage placed between 2006 and 2014 divided into a cohort of (i) those receiving adjuvant 17OHP-C (n=43), and (ii) controls with cerclage alone (n=59).Results:Demographic characteristics were comparable in both groups. There was no significant difference in gestational age at delivery between the cerclage-17OHP-C group (33.4±5.6 weeks) and the cerclage-alone group (34.4±4.6 weeks); P=0.33. We noted a non-significant increase for deliveries <34 weeks in the cerclage-17OHP-C group (44.2%) compared to controls (28.8%) which remained non-significant after adjusting for confounders; P=0.46. There was no statistically significant difference in the rate of delivery <37, 32, 28 and 24 weeks. Adverse neonatal outcomes were comparable in both groups (cerclage-17OHP-C 48.8% vs. cerclage-alone 39%); P=0.43.Conclusion:Intramuscular 17OHP-C in combination with prophylactic cerclage in women with cervical insufficiency and ≥3 second trimester pregnancy losses had no synergistic effect in reducing the rate of recurrent preterm birth or improving perinatal outcomes.

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Effect of hysteroscopic examination on the outcome of in vitro fertilization

Vojnosanitetski pregled ◽

10.2298/vsp1106476t ◽

2011 ◽

Vol 68 (6) ◽

pp. 476-480 ◽

Cited By ~ 7

Author(s):

Aleksandra Trninic-Pjevic ◽

Vesna Kopitovic ◽

Sonja Pop-Trajkovic ◽

Artur Bjelica ◽

Irena Bujas ◽

...

Keyword(s):

Embryo Transfer ◽

Uterine Cavity ◽

Transvaginal Sonography ◽

Vitro Fertilization ◽

Significant Difference ◽

Pregnancy And Delivery ◽

Group A ◽

Group B ◽

Ivf Et

Bacground/Aim. Implantation failure after embryo transfer is one of the main problems of in vitro fartilization (IVF) and intrauterine pathologies can lead to unsuccessful outcome. The aim of this study was to determine if hysteroscopic examination of uterine cavity and consequent treatment of intrauterine lesions prior to IVF could improve the pregnancy rate in women under 38. Methods. This study included 480 patients under 38, who had undergone IVF or IVF\ICSI - embryo transfer cycles, in which one or more good quality embryos were transferred. By transvaginal sonography performed within the past 2 months, the uterus was found normal in all the patients enrolled in our IVF unit. The patients were divided into three groups: group A - with no hysteroscopic evaluation and no pathology, group B - with hysteroscopy but no pathology, and group C - with abnormal hysteroscopy finding and corresponding treatment. Results. The obtained results revaled no difference in the mean age, duration of infertility, number of mature oocytes in either group (p > 0.05). Clinical pregnancy rates in the groups A, B and C were 36.9%, 58.75% and 32.7%, respectively, and delivery rates were 27.5%, 48.7% and 25.7%, respectively. There was a statistically significant difference among the groups concerning pregnancy and delivery rates. Conclusion. Considering the results of this study we could conclude that hysteroscopy, as a routine examination, should be performed before the first IVF-ET cycle in all patients thereby reducing the failures and then the costs of IVF-ET.

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Role of transvaginal ultrasonographic cervical assessment in predicting the outcome of induction of labor

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190296 ◽

2019 ◽

Vol 8 (2) ◽

pp. 628

Author(s):

Kiran Aggarwal ◽

Anita Yadav

Keyword(s):

Predictive Value ◽

Cervical Length ◽

Labor Induction ◽

Induction Of Labor ◽

Labour Induction ◽

Transvaginal Sonography ◽

Bishop Score ◽

Digital Examination ◽

Significant Difference ◽

Successful Induction

Background: Induction of labor is the most common intervention in modern obstetrics. The pre-induction ‘favourability’ of the cervix as assessed by the bishop score is very subjective. Transvaginal sonography appears to be a feasible alternative to the traditional bishop’s score. Aim of this study, was to compare cervical assessment by transvaginal sonography and digital examination in prediction of outcome of labor induction.Methods: Three hundred women at term with maternal and foetal indications for labor induction were included in the study. Modified Bishop score was assessed by digital examination and the cervical length was measured by Transvaginal sonography (TVS). Successful labor induction was taken as a vaginal delivery within 24 hours from the start of induction. Data were analyzed using SPSS for Windows 15.0.Results: Labour induction was successful in 81.33% of patients. Mean cervical length by digital examination was 2.6 cm, whereas the mean sonographic cervical length was 3.4cm. There was a significant difference of 0.8cm in mean cervical length measured by two methods (P=0.01). The best cut off point for predicting successful induction of labor was ≤3.4cm for sonographic cervical length (sensitivity 0.82, specificity 0.87, positive predictive value 0.77 and negative predictive value 0.25). The best cut off point for Modified Bishop score was 2 (sensitivity 0.95, specificity 0.93). The ROC curve showed that compared to TVS cervical length, Modified Bishop score was the best parameter for predicting successful induction of labor.Conclusions: Transvaginal sonographic cervical length measurement can be used as an adjunct tool to the traditional Bishop score for predicting successful labor induction in high risk pregnancies.

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Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures

Journal of Pregnancy ◽

10.1155/2018/4049792 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5

Author(s):

Yuka Sato ◽

Nobuhiro Hidaka ◽

Takahiro Nakano ◽

Saki Kido ◽

Masahiro Hachisuga ◽

...

Keyword(s):

Preterm Delivery ◽

Spontaneous Abortion ◽

Gestational Age ◽

Perinatal Outcomes ◽

Cervical Length ◽

Cervical Cerclage ◽

Extremely Preterm ◽

Term Delivery ◽

Gestational Age At Delivery ◽

Full Term Delivery

Introduction. Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods. We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results. Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions. Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

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Pre-Cerclage Cervical Length—A Reliable Predictor of Long-Term Pregnancy Sustenance After Therapeutic Cervical Cerclage: A Retrospective Study

10.21203/rs.3.rs-900312/v1 ◽

2021 ◽

Author(s):

Emi Kondo ◽

Eiji Shibata ◽

Toshihide Sakuragi ◽

Yukiyo Aiko ◽

Takeshi Kawakami ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcomes ◽

Inflammatory Marker ◽

Cervical Length ◽

Multiple Gestation ◽

Cervical Insufficiency ◽

Term Pregnancy ◽

Cervical Cerclage ◽

Term Birth

Abstract Background: The indication of therapeutic cerclage is still controversial. The purpose of this study was to assess pregnancy outcomes after cervical cerclage in women with shortened cervical length (CL) during pregnancy and/or with a medical history of cervical insufficiency. Methods: We included pregnant women who underwent cerclage in four perinatal medical centers between January 2009 and December 2010. We compared the outcomes of cerclage in terms of non-term and term births, as well as successful and unsuccessful cerclages. Cervical cerclage was defined as successful if pregnancy was continued for more than 13 weeks post-cerclage. Therapeutic and prophylactic cerclages were performed in pregnant women with pre-cerclage CL < 25 mm and ≥ 25 mm, respectively.Results: We screened 114 pregnant women, of whom 91 were included; 15 and 8 women were excluded for unknown pregnancy outcomes and multiple gestation, respectively. The rate of therapeutic cerclage was significantly higher in the non-term birth (68% vs. 38%, p <0.01; non-term group vs. term birth group), unsuccessful cerclage (79% vs. 43%, p =0.01; unsuccessful cerclage vs. successful cerclage) groups. Inflammatory marker levels (white blood cell count and C-reactive protein) were normal in both group sets, albeit no significantly different between-group differences. Receiver-operating characteristic curve analysis revealed that 87% of patients with pre-cerclage CL ≥ 17 mm sustained their pregnancies for more than 13 weeks post-cerclage. However, 64% of patients with pre-cerclage CL < 17 mm did not sustain their pregnancies for more than 13 weeks post-cerclage.Conclusions: Therapeutic cerclage should be performed in patients with cervical insufficiency having CL ≥ 17 mm, for long-term pregnancy sustenance.

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

10.36106/gjra/1712657 ◽

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.

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Pregnancy Outcome after Cerclage for Cervical Incompetence at a Private Hospital of Dhaka

Faridpur Medical College Journal ◽

10.3329/fmcj.v12i2.34234 ◽

2017 ◽

Vol 12 (2) ◽

pp. 78-81

Author(s):

Shafeya Khanam ◽

Maliha Rashid ◽

Ayesha Siddika Purobi ◽

Zebunnessa Parvin ◽

Sanjoy Kumar Das ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Fetal Loss ◽

Cervical Dilatation ◽

Cervical Insufficiency ◽

Miscarriage Rate ◽

Cervical Cerclage ◽

Cervical Incompetence ◽

Obstetric Population

Miscarriage, particularly recurrent mid-trimester miscarriage is a distressful condition. This form of miscarriage and preterm birth appear to have some etiologies. An important etiology is cervical incompetence that describes a disorder in which painless cervical dilatation leads to recurrent second trimester pregnancy losses. Every year more than 10 million preterm birth occurs and more than 1 million baby die from this common complication of pregnancy. The incidence of true cervical insufficiency is estimated at less than 1% of the obstetric population. In the index pregnancy, findings indicative of possible cervical insufficiency include cervical funneling, cervical shortening, and overt cervical dilatation. The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with cervical incompetence. This is a retrospective observational study conducted over a period of twelve months. All cases delivered in Central Hospital were assisted by consultant obstetricians, in which 16(61.5%) out of 26 cases were delivered by caesarean section. Miscarriage rate was 11.53%. Out of the caesarean deliveries 2(12.5%) were at term and 14(87.5%) were at preterm. In this study 3(21.42%) babies born at 32nd and 33rd weeks, 6(42.85%) at 34th week and 2(14.28%) were at 35th week. There was no fetal loss. Extreme low birth weight was only one, 7(43.75%) of the babies had normal body weight for the area of study, 8 babies (50%) had low birth weight. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.Faridpur Med. Coll. J. Jul 2017;12(2): 78-81

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Variation in Cervical Length over Time during a Single Transvaginal Ultrasound Examination

American Journal of Perinatology ◽

10.1055/s-0038-1676616 ◽

2018 ◽

Vol 36 (08) ◽

pp. 781-784

Author(s):

Katherine A. Connolly ◽

Luciana Vieira ◽

Elizabeth M. Yoselevsky ◽

Stephanie Pan ◽

Joanne L. Stone

Keyword(s):

Correlation Coefficient ◽

Intraclass Correlation Coefficient ◽

Ultrasound Examination ◽

Transvaginal Ultrasound ◽

Intraclass Correlation ◽

Cervical Length ◽

Linear Mixed Effect Model ◽

Mixed Effect ◽

Time Points ◽

Significant Difference

Objective To quantify the degree of change in cervical length (CL) over a 3-minute transvaginal ultrasound. Study Design We conducted a prospective observational study of nulliparous patients who underwent routine transvaginal CL screening at the time of their second-trimester ultrasound. We recorded CL at four time points (0, 1, 2, 3 minutes) and compared these values to determine the minute-to-minute change within a single patient. Results A total of 771 patients were included. The mean gestational age was 20.8 weeks (±0.84). We used a linear mixed effect model to assess if each minute during the ultrasound is associated with a change in CL. The intraclass correlation coefficient between minute 0 to minute 3 was 0.82 (95% confidence interval: 0.80, 0.84). This indicates that there is a relatively high within-patient correlation in CL during their ultrasound. Additionally, we stratified patients based on their starting CL; the intraclass correlation coefficient remained high for all groups. We additionally compared CL at each minute. Although there is a statistically significant difference between several time points, the actual difference is small and not clinically meaningful. Conclusion The variation in CL over a 3-minute transvaginal ultrasound examination is not clinically significant. It may be reasonable to conduct this examination over a shorter period.

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