TRANSABDOMINAL CERCLAGE AND PERINATAL OUTCOMES – A FIVE YEARS RETROSPECTIVE STUDY

Dr. Praful Doshi, Dr. Gouri Bhatt, Dr. Mitsu Doshi, Dr.Akash Patel, Dr. Hitanshu Bhatt, Dr. Saniya Goel

Abstract


Abstract

Background: Transabdominal placement of a cervical cerclage appears to be safe and effective procedure in reducing pregnancy loss in selected patients with cervical incompetence. It can be placed almost at the internal os, by laparoscopy or laparotomy, in non-pregnant or pregnant state and can be left in situ till the woman’s obstetric career is complete.

Objective: The purpose of this study was to evaluate the effectiveness of transabdominal cerclage placement, in terms of obstetric and perinatal outcomes in the study population.

Material and methods: We conducted a five years retrospective study on consecutive women undergoing transabdominal cerclage from 2010 to 2015 at ’Me and Mummy’ hospital, Surat (Gujarat). Data was retrieved from medical records. Eligible women had past history suggestive of cervical incompetence, previous failed transvaginal cerclage or short cervix unfavourable for transvaginal cerclage. The primary outcome of the study was to measure neonatal survival rate whereas the secondary outcomes were delivery after 34 weeks of gestation and procedure related complications.

Results: Total 25 women underwent transabdominal cerclage during the study period. In 24 women the procedure was done by laparoscopy and in one woman laparotomy was done. Twenty two women underwent interval cerclage and three women underwent antenatal placement of cerclage. Total 17 pregnancies and 21 foetuses were evaluated during the study period (four pairs of twins). Neonatal survival rate was 95.65 % ( 20 of 21 babies). Out of 17 women, 11 women delivered after 37 weeks (64.70%), four women after 34 weeks (23.52%), one woman after 28 weeks of gestation and one woman had inevitable miscarriage within one week of procedure. There were no procedure related complications.

Conclusion: Transabdominal cerclage in selective cases and in expert hands is a safe and effective procedure resulting in favourable obstetric and neonatal outcomes in women with poor obstetric history due to cervical incompetence.

Keywords: Transabdominal cerclage; Cervical incompetence; Transvaginal cerclage; Laproscopy


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