A Ten-year Retrospective Analysis of Fetomaternal Outcome in Women who had Cervical Cerclage in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Abstract

Background: Cervical incompetence is a major cause of recurrent mid-trimester pregnancy losses with profound psychological effect on affected women. Intervention with the use of cervical cerclage has been shown to be generally beneficial. Aim: The aim of the study was to determine the prevalence of cervical incompetence and the feto-maternal outcomes following cervical cerclage in patients with cervical incompetence at the University of Port Harcourt Teaching Hospital (UPTH) over a ten-year period. Methodology: This was a ten-year retrospective review of case files of patients who had cervical cerclage for cervical incompetence in the University of Port Harcourt Teaching Hospital from January 2009 to December 2018. The records of 130 patients who had cervical cerclage within the study period were reviewed and relevant information extracted and analysed using SPSS version 25 software package. Chi square test was used to compare categorical variables and p value < 0.05 was considered significant. Results: The prevalence of cervical cerclage for cervical incompetence was 0.3%. The mean age was 33.6+ 5.3 years and majority were nulliparous 62 (47.7%), with most of them 116 (89.2%) had had a previous mid-trimester miscarriage. All the patients had elective prophylactic cerclage. Outcome of cerclage was adjudged good in 106 (81.5%) cases and failed in 24 (18.5%) cases based on the gestational age at the end of the pregnancy and the fetal outcome. The most frequent complication following cerclage was preterm prelabour rupture of membranes 10 (7.7%). Of the 116 patients with previous mid-trimester miscarriages, 94 (81.0%) had good outcome while 22 (19.0%) had poor outcome. Patients with no prior history of dilatation and curettage had better pregnancy compared to those with previous dilatation and curettage (p=0.01). Conclusion: Cervical cerclage resulted in improved pregnancy outcome in 81.0% of women with previous mid-trimester pregnancy losses. Patients with no previous history of dilatation and curettage had better pregnancy outcome.