Abstract

Background; Cervical Cerclage has been reported to prevent preterm births in females having cervical incompetence who have prior history of preterm births. This study was conducted to document frequency of preterm labor in women with cervical incompetence having cervical cerclage.

Aim: To determine frequency of preterm labor in pregnant women with cervical incompetence having cervical cerclage at a tertiary care hospital.

Methods; This descriptive case series was done at department of obstetrics and gynecology, Unit I Nishtar Hospital Multan which is a tertiary care hospital using non – probability purposive sampling technique. A total of 156 patients with Cervical incompetence (Cervical length less than 25 mm at 24 weeks of gestational age (on ultrasound) were included. Purse string suture was applied at cervicovaginal junction, without bladder mobilization under general anesthesia. Patients were monitored for 24 – 48 hours post – operatively and were asked to refrain from heavy physical activities and coitus.

Results: Mean age of these patients was noted to be 28.10±4.09 years and 104(66.7%) patients were aged 20–30 years. History of diabetes was present in 21(13.5%) and hypertension in 31(19.9%). Mean height of our study cases was 161.31±5.22 centimeters while mean weight was noted to be 56.23±6.21 kilograms. Mean BMI was 23.41±2.47kg/m2 and obesity was present in 33(21.2%). Mean inter-pregnancy interval was noted to be 10.45±5.67 months while short interpregnancy interval was noted in 42(26.9%) of our study cases. Elective cerclage was present in 114(73.1%) while emergency cerclage was present in 42(26.9%) study cases. Mean parity was 3.47±1.19 and 113(72.4%) study cases had parity up to 4 while mean gravidity was 5.13±1.87 and 105(67.3%) had gravidity more than 5. Mean gestational age at the time recruitment of our study cases was 12.64±0.99 weeks while mean gestational age at delivery was noted to be 38.74 ± 2.17 weeks. Preterm labor was noted in 32(20.5%) of our study cases.

Conclusion: Cervical cerclage is an effective procedure for the prevention of preterm births as the frequency of preterm labor was low in women with cervical vaginal cerclage having previous recurrent preterm births in our study. There were no major adverse side effects of the treatment and hence can be employed safely. Preterm labor was significantly associated with history of diabetes, hypertension, obesity, gravidity and type of cerclage.

Keywords: Preterm labor, cervical incompetence, cervical cerclage