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

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.

Vaginal cervicoisthmic cerclage for cervical incompetence in pregnant women: Fernandez’s technique in 8 steps

Video objective: To demonstrate that surgical technique of vaginal cervicoisthmic cerclage must be performed in women with history of cervical incompetence with more than two late miscarriages before 24 weeks or premature deliveries before 28 weeks and after prior failure of preventive Mc Donald cerclage. In this video, the authors describe the complete procedure in 8 steps to standardize and facilitate the procedure in a simple and safe way during pregnancy. Design: Step-by-step video demonstration of the surgical technique. Setting: Tertiary Center for University Hospital.

Frequency of Success Rate of Cervical Cerclage in Preventing Preterm Deliveries

Objective: Determination of success rate of cervical cerclage in prevention of preterm deliveries in patients with cervical incompetence. Study Design: Case Series study. Place and Duration of Study: Study was conducted at Khyber Teaching Hospital for a period of six months from 29 March, 2018 to 29 September, 2018. Methodology: 97 pregnant women were recruited who had a history of previous miscarriages or pre-term delivery. Cervical Cerclage was performed on these patients who were then observed till delivery to ascertain the success rate of cervical cerclage in preventing pre-term deliveries in these patients. Results: In this study mean age was 30 years with SD 8.316. 63% patients were nulli para (with previous second trimester losses) and 37% patients were multi para (with previous pre-term deliveries). 78% delivered at term and 22% delivered preterm. 80% of babies delivered with good apgar score and weight greater than 2.5 kg where as 20% of babies delivered with low apgar score and weight less than 2.5kg. Overall success rate of cervical cerclage was 80%. Conclusion: Our study concluded that success rate of cervical cerclage was 80% in preventing pre-term deliveries in patients having cervical incompetence. Keywords: Cervical Cerclage, Pre-term deliveries, Cervical incompetence, Trans-vaginal

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

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.

Medical and obstetric factors associated with preterm deliveries among women of childbearing age at Pumwani maternity hospital, Nairobi County, Kenya

Background: The rate of pre-term birth (PTB) in Kenya stands at 12.3%. Preterm deliveries are associated with high neonatal mortality and have a huge financial burden on the parents and the government. Prematurity is also associated with chronic diseases like diabetes and hypertension in adult life. The study objective was to determine the medical1and obstetric factors1associated1with preterm deliveries among women of childbearing age (15-49 years) at Pumwani maternity hospital (PMH).Methods: A hospital-based cross-sectional study was conducted among 191 mothers of reproductive age (15-49 years) who delivered at PMH during the study period. Data was collected using a questionnaire and a data abstraction tool. Descriptive statistics were used to summarize categorical variables. Chi-square was used to test for the strengths of associations. Prevalence adjusted odds ratios (PAOR) were used to estimate the strengths of associations.Results: The study found that the association between past pregnancy (p=1.0), history of surgery (p=1.0), medication (p=1.0), urinary tract infection (p=0.453), miscarriage (p=1.0) and chronic disease (p=0.395) and preterm delivery among women of child bearing age (15-49 years) at PMH was not statistically significant. The association between premature delivery (p=0.021), parity (p=0.000), premature rapture of membranes (PROM) (p=0.000), antepartum hemorrhage (APH) (p=0.045), cervical incompetence (p=0.001), pre-eclampsia toxemia (PET) (p=0.000), and placenta abruption complications (p=0.009) and preterm delivery was statistically significant.Conclusions: The association between premature delivery, parity, PROM, APH, cervical incompetence, PET and placenta abruption complications and preterm delivery was statistically significant.

Connective tissue dysplasia in the genesis of cervical incompetence

Aim: to study a role of undifferentiated connective tissue dysplasia (uCTD) in etiology of cervical incompetence and its effect on pregnancy and childbirth course.Material and Methods. There were enrolled 60 patients with cervical incompetence. Patients were divided into 3 groups according to the modified CTD scale: group 1 - patients without uCTD (n = 21); group 2 - patients with mild uCTD (n = 25); group 3 - patients with moderate-to-severe uCTD (n = 14). Intensity of CTD clinical signs was assessed based on health status, gynecological and obstetric history, the course of pregnancy, labor and the postpartum period.Results. It was found that patients with more prominent CTD developed earlier (r-Spearman = -0.26) and more marked (r-Spearman = -0.29) cervical shortening and opening of the internal orifice of the uterus (r-Spearman = 0.28). It was also noted that likelihood of occurring preterm labor was significantly higher in patients with CTD (p = 0.02).Conclusion. The data obtained evidence that uCTD affects intensity of manifested cervical insufficiency and rate of preterm delivery.

A successful full term delivery in a case of robotic assisted insertion of transabdominal cerclage in an obese woman with multiple uterine fibroids

Cervical incompetence is not an uncommon presentation in an obstetric emergency unit. Some of these patients will be managed with a cervical cerclage. While the management of patients presenting with first time cervical incompetence is relatively established, the management of patient with repeated cervical incompetence might require an abdominal cerclage. Abdominal cerclages can be inserted traditionally via laparotomy or via a minimally invasive approach (MIS). We present a case of an obese patient presenting with 3 previous second trimester miscarriages despite 2 cervical cerclage complicated by multiple uterine fibroids who underwent a robotic assisted insertion of transabdominal cerclage (RTAC) pre-pregnancy. She subsequently conceived spontaneously and carried the pregnancy to term and delivered a healthy baby via caesarean section. There have been multiple published studies showing that an MIS approach for abdominal cerclage insertion is safe and viable. Robotic assisted procedures allow for better visualisation and manipulation of tissue especially in patients anticipating a complex procedure. For our patient we feel that a robotic assisted procedure would be more beneficial given her profile and the complexity of her case.