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|Year : 1985 | Volume
| Issue : 3 | Page : 155-7
The place of elective cerclage operation for cervical incompetence during pregnancy.
Deshpande VV, Bhattacharya MM
|How to cite this article:|
Deshpande V V, Bhattacharya M M. The place of elective cerclage operation for cervical incompetence during pregnancy. J Postgrad Med 1985;31:155
|How to cite this URL:|
Deshpande V V, Bhattacharya M M. The place of elective cerclage operation for cervical incompetence during pregnancy. J Postgrad Med [serial online] 1985 [cited 2020 Mar 28];31:155. Available from: http://www.jpgmonline.com/text.asp?1985/31/3/155/5395
Incompetence of the cervix is a recognised obstetric entity responsible for late abortions or early premature deliveries. It usually starts with spontaneous dilatation and effacement of the cervix and subsequent rupture of membranes followed by quick abortions with minimal blood loss. Tightening of cervical os is the recommended management to prevent pregnancy wastage due to incompetent os. There are instances where tightening is done even in a primigravida without any history of previous surgical trauma.
The study included results of 100 cases of incompetent os, who were diagnosed during pregnancy and had undergone cerclage operation during, the period of 5 years i.e. 1976-1980 at the K.E.M. Hospital, Bombay, India. The patients were between 18 and 35 years of age. 73% of these were in the age group of 21-30, the youngest being 17 years old.
McDonald's method of cerclage operation was employed in 71 patients whereas 29 had undergone Shirodkar's operation. In 55 patients, the operation was performed after they presented with the clinical picture of incompetent os while 45 patients had undergone the operation prophylactically (electively) before dilatation of cervix. All these patients were given prophylactic antibiotics and uterine relaxants during and after the operation.
The outcome of pregnancy of all these cases was studied to find out the factors influencing the success of cerclage operation.
The outcome of pregnancy in 100 cases was as follows: 60 patients had full term live births (7 out of these had undergone lower segment caeserean section), 12 patients had pre-term live births with favourable outcome, 6 patients delivered full term still born babies, 8 had pre-term still births and 14 patients aborted.
Factors affecting the success rate of cerelage operation in 72 patients who had favourable outcome are shown in [Table - 1].
Three patients who had undergone McDonald's operation required re-tightening as the knot slipped out and the cervix opened again. The first operation was performed at 12 weeks' gestational period in two cases and at 14 weeks in one case. Two out of these 3 aborted and one underwent LSCS with favourable outcome.
Various factors which influence the outcome after cerclage operation are the gestational period at which tightening is done, the method of tightening and the condition of the cervix.
The presumptive diagnosis of incompetent os is established with the clinical history of repeated painless dilatation of the cervix. However, other possible systemic as well as local causes of abortion should be excluded before taking the patient for cerclage operation.
The gestational period at which the operation is advocated by majority is 1428 weeks. The optimum time for performing the cerclage in a known case of incompetent os as well as its place in a primigravida is open to question.
In our study, the success rate was more (91%) when the cerclage operation was done prophylactically (i.e. before the cervix showed any signs of incompetence during pregnancy) as compared to those who presented with dilated and effaced cervix. Aarnoudse and Haisjes have reported a success rate of 72% in a series of 55 cerclage operations. Harger and Peters et al have shown a higher success rate in prophylactically performed cerclage operations.
In our study, Shirodkar's method or McDonald's procedure did not alter the outcome. Similar reports are available from Peters et a l. But, Harger showed that caeseraen section rates and sub sequent maternal morbidity were more with Shirodkar's operation than with McDonald's. According to them, equivalent success rate and morbidity lead to a conclusion that the ease of procedure favoured McDonald's procedure.
The pregnancy outcome is significantly improved after cervical cerclage in cases of incompetent os and to attain the optimum results cerclage should be performed prophylactically between 14 and 28 weeks of pregnancy.
|1.||Aarnoudse, J. G. and Haisjes, H. J.: Complication of cerclage. Acta Obstet. Gynaecol. Scandinav., 58: 255-257, 1979. |
|2.||Harger, J. H.: Comparison of success and morbidity in cervical cerclage procedures. Obstet. Gynaecol. Survey, 36: 189-190, 1981. |
|3.||McDonald, I. A.: Suture of the cervix for inevitable miscarriage. J. Obstet. & Gynaecol. Brit. C'wlth., 64: 346-350, 1957. |
|4.||Peters, W. A. III, Thiagarajah, S. and Guytt, H. Jr.: Cervical cerclage; twenty years' experience. Southern Med. J., 72: 933-937, 1979. |
|5.||Shirodkar, V. N.: A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic, 299: 52-54, 1955. |