A 10-year review of the maternal and neonatal outcomes in patients with
history-indicated, ultrasound-indicated and rescue cervical cerclages; a
retrospective study.
Abstract
Objective: To assess differences in cervical cerclage success
rates, maternal and neonatal outcomes in patients with
history-indicated, ultrasound-indicated and rescue cerclages, and
identify factors associated with these differences. Design: A
retrospective study of patients with cervical cerclages between January
2008 and October 2017 at National University Hospital, Singapore was
performed. Method: Patients’ data was extracted from electronic
health records and analysed. 163 cerclages were inserted; 14 patients
were lost-to-follow-up and excluded. Results: The details of
149 cerclages were analysed (history-indicated, n=83,
ultrasound-indicated, n=39, and rescue cerclages, n=27). Patients with
rescue cerclages had the lowest cerclage success rate of 55.56%,
defined as pregnancies continuing beyond 24 weeks. Patients with
history-indicated and ultrasound-indicated cerclages had similarly high
success rates of 91.57% and 92.31% respectively. Rescue cerclages,
twin pregnancies, larger cervical dilation at presentation, pre-existing
type 2 diabetes mellitus and Indian ethnicity were significantly
associated with cerclage failure. Patients with rescue cerclages had the
highest proportion of patients with one or more maternal complications,
and highest rates of preterm premature rupture of membranes and preterm
labour. Patients with rescue cerclages also had the lowest neonatal
survival rate, lowest mean birth weight and highest proportion of
neonatal complications i.e. respiratory distress syndrome,
intraventricular haemorrhage, necrotising enterocolitis, and
hypoxic-ischemic encephalopathy. Conclusion: Maternal and
neonatal outcomes are significantly poorer in women with rescue
cerclages, compared to patients with history-indicated and
ultrasound-indicated cerclages. Appropriate assessment of risk factors
for cervical incompetence and serial cervical length monitoring may
reduce rescue cerclages, which may improve outcomes.