Subsequent Pregnancy Outcomes Following Prepregnancy Cerclage in Patients with Absent Ecto Cervix
Abstract
Background: We aimed to determine whether the prepregnancy cerclage for women with cervical incompetence with absent ecto‑cervix affects the time from surgery to conception and subsequent pregnancy outcome.
Methods: This retrospective study was carried out on patients with at least one previous history of second-trimester abortion and extremely short cervix found by gynecological examination. A total of 40 cases of McDonald's cerclage before pregnancy were performed. The time from surgery to conception and pregnancy outcome were followed up for 4 years. The main outcomes were the time from surgery to conception, and the gestational week of delivery, miscarriage rate, preterm delivery rate.
Results: Between September 2018 and December 2022, 37 women became pregnant following prepregnancy cerclage. In total, 36 babies were born to 37 mothers. The recurrence rate of second-trimester miscarriage was 8.11% (3/37) and the preterm birth rate was 29.73% (11/37). Mean time from surgery to conception was 38w (range 2w-160w).Mean gestational age at delivery was 36 weeks +4 (256 days).The live birth rate was 100%. There were no maternal complications, no intestinal and bladder injuries.
Conclusion: Cervical incompetence patients with absent ecto‑cervix may benefit from prepregnancy cerclage without affecting the interpregnancy interval.
1. Alfirevic Z, Stampalija T, Medley N (2017). Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev, 6: CD008991.
2. Shennan A, Story L, Jacobsson B, Grobman WA (2021). FIGO Working Group for Preterm Birth (2021). FIGO good practice recommendations on cervical cerclage for prevention of preterm birth. Int J Gynaecol Obstet, 155(1): 19-22.
3. Sundtoft I, Langhoff-Roos J, Sandager P, et al (2017). Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix. Acta Obstet Gynecol Scand, 96(8): 984-90.
4. Hamou B, Sheiner E, Coreanu T, et al (2020). Intrapartum cervical lacerations and their impact on future pregnancy outcome. J Matern Fetal Neonatal Med, 33(5): 883-7.
5. V S (1955). A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic, 52: 299-300.
6. Mcdonald IA (1957). Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp, 64(3): 346-50.
7. Owen J, Hankins G, Iams JD, et al (2009). Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol, 201(4): 375.e1-8.
8. Namouz S, Porat S, Okun N, et al (2013). Emergency cerclage: literature review. Obstet Gynecol Surv, 68(5): 379-88.
9. Wierzchowska-Opoka M, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B (2021). Emergency Cervical Cerclage. J Clin Med, 10(6):1270.
10. Benson RC, Durfee RB (1965). Transabdominal Cervico Uterine Cerclage during Pregnancy for the Treatment of Cervical Incompetency. Obstet Gynecol, 25: 145-55.
11. Witt MU, Joy SD, Clark J, et al (2009). Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol, 201(1): 105.e1-4.
12. Scibetta JJ, Sanko SR, Phipps WR (1998). Laparoscopic transabdominal cervicoisthmic cerclage. Fertil Steril, 69(1): 161-3.
13. Ades A, Aref-Adib M, Parghi S, Hong P (2019). Laparoscopic transabdominal cerclage in pregnancy: A single centre experience. Aust N Z J Obstet Gynaecol, 59(3): 351-5.
14. Moawad GN, Tyan P, Bracke T, et al (2018). Systematic Review of Transabdominal Cerclage Placed via Laparoscopy for the Prevention of Preterm Birth. J Minim Invasive Gynecol, 25(2): 277-86.
15. von Elm E, Altman DG, Egger M, et al (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology, 18(6): 800-4.
16. Marchand GJ, Masoud AT, Galitsky A, et al (2021). Complications of Laparoscopic and Transabdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol, 28(4): 759-768.e2.
17. Jarde A, Lutsiv O, Beyene J, McDonald SD (2019). Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG, 126(5): 556-67.
18. EPPPIC Group (2021). Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet, 397(10280): 1183-94.
19. Enakpene CA, DiGiovanni L, Jones TN, et al (2018). Cervical cerclage for singleton pregnant patients on vaginal progesterone with progressive cervical shortening. Am J Obstet Gynecol, 219(4): 397.e1-397.e10.
20. Dugoff L, Berghella V, Sehdev H, et al (2018). Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial. Ultrasound Obstet Gynecol, 51(5): 573-9.
21. Norman JE, Marlow N, Messow CM, et al (2016). Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet, 387(10033): 2106-16.
22. Goldstein RR, Croughan MS, Robertson PA (2002). Neonatal outcomes in immediate versus delayed conceptions after spontaneous abortion: a retrospective case series. Am J Obstet Gynecol, 186(6): 1230-4.
23. Basso O, Olsen J, Knudsen LB, et al (1998). Low birth weight and preterm birth after short interpregnancy intervals. Am J Obstet Gynecol, 178(2): 259-63.
24. Cuisinier M, Janssen H, de Graauw C, et al (1996). Pregnancy following miscarriage: course of grief and some determining factors. J Psychosom Obstet Gynaecol, 17(3): 168-74.
25. World Health Organization (2007). Report of a WHO technical consultation on birth spacing. https://www.who.int/publications/i/item/WHO-RHR-07.1
26. Edlow AG, Srinivas SK, Elovitz MA (2007). Second-trimester loss and subsequent pregnancy outcomes: What is the real risk? Am J Obstet Gynecol, 197(6): 581.e1-6.
27. Zhang X, Tong J, Ma X, et al (2020). Evaluation of cervical length and optimal timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia: A retrospective study. Medicine (Baltimore), 99(49): e23411.
2. Shennan A, Story L, Jacobsson B, Grobman WA (2021). FIGO Working Group for Preterm Birth (2021). FIGO good practice recommendations on cervical cerclage for prevention of preterm birth. Int J Gynaecol Obstet, 155(1): 19-22.
3. Sundtoft I, Langhoff-Roos J, Sandager P, et al (2017). Cervical collagen is reduced in non-pregnant women with a history of cervical insufficiency and a short cervix. Acta Obstet Gynecol Scand, 96(8): 984-90.
4. Hamou B, Sheiner E, Coreanu T, et al (2020). Intrapartum cervical lacerations and their impact on future pregnancy outcome. J Matern Fetal Neonatal Med, 33(5): 883-7.
5. V S (1955). A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic, 52: 299-300.
6. Mcdonald IA (1957). Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp, 64(3): 346-50.
7. Owen J, Hankins G, Iams JD, et al (2009). Multicenter randomized trial of cerclage for preterm birth prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol, 201(4): 375.e1-8.
8. Namouz S, Porat S, Okun N, et al (2013). Emergency cerclage: literature review. Obstet Gynecol Surv, 68(5): 379-88.
9. Wierzchowska-Opoka M, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B (2021). Emergency Cervical Cerclage. J Clin Med, 10(6):1270.
10. Benson RC, Durfee RB (1965). Transabdominal Cervico Uterine Cerclage during Pregnancy for the Treatment of Cervical Incompetency. Obstet Gynecol, 25: 145-55.
11. Witt MU, Joy SD, Clark J, et al (2009). Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol, 201(1): 105.e1-4.
12. Scibetta JJ, Sanko SR, Phipps WR (1998). Laparoscopic transabdominal cervicoisthmic cerclage. Fertil Steril, 69(1): 161-3.
13. Ades A, Aref-Adib M, Parghi S, Hong P (2019). Laparoscopic transabdominal cerclage in pregnancy: A single centre experience. Aust N Z J Obstet Gynaecol, 59(3): 351-5.
14. Moawad GN, Tyan P, Bracke T, et al (2018). Systematic Review of Transabdominal Cerclage Placed via Laparoscopy for the Prevention of Preterm Birth. J Minim Invasive Gynecol, 25(2): 277-86.
15. von Elm E, Altman DG, Egger M, et al (2007). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Epidemiology, 18(6): 800-4.
16. Marchand GJ, Masoud AT, Galitsky A, et al (2021). Complications of Laparoscopic and Transabdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol, 28(4): 759-768.e2.
17. Jarde A, Lutsiv O, Beyene J, McDonald SD (2019). Vaginal progesterone, oral progesterone, 17-OHPC, cerclage, and pessary for preventing preterm birth in at-risk singleton pregnancies: an updated systematic review and network meta-analysis. BJOG, 126(5): 556-67.
18. EPPPIC Group (2021). Evaluating Progestogens for Preventing Preterm birth International Collaborative (EPPPIC): meta-analysis of individual participant data from randomised controlled trials. Lancet, 397(10280): 1183-94.
19. Enakpene CA, DiGiovanni L, Jones TN, et al (2018). Cervical cerclage for singleton pregnant patients on vaginal progesterone with progressive cervical shortening. Am J Obstet Gynecol, 219(4): 397.e1-397.e10.
20. Dugoff L, Berghella V, Sehdev H, et al (2018). Prevention of preterm birth with pessary in singletons (PoPPS): randomized controlled trial. Ultrasound Obstet Gynecol, 51(5): 573-9.
21. Norman JE, Marlow N, Messow CM, et al (2016). Vaginal progesterone prophylaxis for preterm birth (the OPPTIMUM study): a multicentre, randomised, double-blind trial. Lancet, 387(10033): 2106-16.
22. Goldstein RR, Croughan MS, Robertson PA (2002). Neonatal outcomes in immediate versus delayed conceptions after spontaneous abortion: a retrospective case series. Am J Obstet Gynecol, 186(6): 1230-4.
23. Basso O, Olsen J, Knudsen LB, et al (1998). Low birth weight and preterm birth after short interpregnancy intervals. Am J Obstet Gynecol, 178(2): 259-63.
24. Cuisinier M, Janssen H, de Graauw C, et al (1996). Pregnancy following miscarriage: course of grief and some determining factors. J Psychosom Obstet Gynaecol, 17(3): 168-74.
25. World Health Organization (2007). Report of a WHO technical consultation on birth spacing. https://www.who.int/publications/i/item/WHO-RHR-07.1
26. Edlow AG, Srinivas SK, Elovitz MA (2007). Second-trimester loss and subsequent pregnancy outcomes: What is the real risk? Am J Obstet Gynecol, 197(6): 581.e1-6.
27. Zhang X, Tong J, Ma X, et al (2020). Evaluation of cervical length and optimal timing for pregnancy after cervical conization in patients with cervical intraepithelial neoplasia: A retrospective study. Medicine (Baltimore), 99(49): e23411.
| Files | ||
| Issue | Vol 53 No 11 (2024) | |
| Section | Original Article(s) | |
| Keywords | ||
| Ecto cervix Prepregnancy cerclage Pregnancy outcome | ||
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How to Cite
1.
Lu J, Zhou L, Xu M, Yang L, Li X. Subsequent Pregnancy Outcomes Following Prepregnancy Cerclage in Patients with Absent Ecto Cervix. Iran J Public Health. 2024;53(11):2500-2508.
