Abstract

First described in 1902, cervical cerclage is the insertion of a suture into the cervix during pregnancy with the aim of preventing preterm delivery. It is usually done in cases suggestive of an “incompetent cervix”; either as elective or emergency procedures.

We retrospectively reviewed 13 cases of cervical cerclage at Poole Hospital NHS Foundation Trust between June 2008 and April 2011, to assess current practice within the department.

Using RCOG green-top guideline definitions there were 5 cases of rescue cerclage and 7 of ultrasound-indicated cerclages. 1 cerclage attempt was unsuccessful. All of the sutures were placed transvaginally, with no bladder mobilisation (McDonald technique). There were no intra-operative complications.

50% of women had a live delivery, all after 24 weeks gestation. 3 women had deliveries beyond 37 weeks gestation and one pregnancy was ongoing at the time of the review. There were 2 babies admitted to the neonatal unit, with 1 neonatal death.

8 women required emergency suture removal before 28 weeks gestation; commonly for ruptured membranes and chorionamnionitis. 3 women went into premature labour and 1 had an intrauterine death secondary to cord prolapse. Infection was the most common maternal complication.

Overall, practise varied little between clinicians for cerclage technique, though documentation was often insufficient for comparison of factors such as use of concomitant antibiotics, indomethacin or progesterone. The new RCOG guideline should help guide patient selection and provide formal audit standards.