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Pregnancy outcomes following cervical cerclage in the east of scotland
  1. M R Smith,
  2. K E Orr,
  3. A E Nicoll
  1. Ninewells Hospital, NHS Tayside, Dundee, UK

Abstract

Aims To identify women who had cervical cerclage in Ninewells Hospital, Dundee and the indications for cerclage. Furthermore to assess techniques used, whether tocolysis was administered and to examine pregnancy outcomes for these women.

Methods Women who had cervical cerclage between January 2004 and September 2010 were identified from the maternity theatre records. The maternity case notes and the local maternity database were used to obtain information about the procedures and pregnancy outcomes.

Results 27 women had 29 pregnancies that required cervical cerclage. 14/29 (48%) were elective procedures and 15/29 (52%) were emergency procedures. All women that had elective cerclage had a history of previous mid-trimester spontaneous abortion and all women that had emergency cerclage had clinical or ultrasound evidence of cervical shortening and/or dilatation. The McDonald technique and Mersilene tape were used for all cases. Tocolysis was used in 20/29 (70%) cases (elective=7/14 (50%) vs emergency=13/15 (87%)).

The median gestational age of pregnancy outcome was 31 weeks (range=12–41 weeks) (elective=23 weeks vs emergency=34 weeks). 8/29 (28%) women had spontaneous abortion before 24 weeks gestation (elective=2/14 (14%) vs emergency=6/15 (40%)). 11/29 (38%) women delivered between 24 and 37 weeks gestation (elective=6/14 (43%) vs emergency=5/15 (33%)) 10/29 (34%) women delivered at Term (elective=6/14 (43%) vs emergency=4/15 (27%)).

Conclusions In our unit cervical cerclage is performed infrequently. Nevertheless there is consistency in the surgical techniques used for both elective and emergency procedures. Tocolysis is administered more frequently for emergency procedures. For emergency cerclage the majority of women will either miscarry or deliver before Term. Outcomes appear to be better for elective procedures.

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