Publication: Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital
Date
2010
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Cervical incompetence is one of the main contributors to repeated pregnancy loss,
accounting for approximately 25% of the cases. Typically it results in progressive
cervical dilatation, leading to a painless second- or early-third-trimester abortion.
Objectives
The main objective of the study was to explore the benefit from cervical cerclage in
pregnant women with anatomical cervical incompetence
Methods
In a review of the operation and labour registers from January 2006 till January 2010, a
total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In
the study caste, parity, gestational age, diagnostic criteria, postoperative complications
and pregnancy outcomes of the cases were analyzed.
Results
Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University
Teaching Hospital). Four women haven’t delivered at the time of data analysis. So
pregnancy outcomes were analyzed among 32 cases while rests of the variables were
analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were
between 20-25 years old and 32 cases (84%) were from Kavre district.
All cases were booked cases (they had antenatal care in the hospital) and 14 patients
(37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two
cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history
of at least one dilatation and evacuation.
33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed
by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-
trimester abortion, of having a high suspicion of cervical incompetence after mid-
trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage
were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in
all 38 cases.
All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases
(59%) were delivered vaginally at term.
Conclusions
38 cases were included in the study. Pregnancy outcomes were analyzed among 32
cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were
delivered with good foetal weight. It clearly shows pregnant women with anatomical
cervical incompetence were benefitted from cervical cerclage.
The authors recommend an early trans vaginal scan in any patient with a history of mid
trimester abortion or preterm labour. The cervical cerclage procedure therefore should
be available more widely to benefit those patients with proven or strongly suspected
cervical incompetence.
Key Words
cervical incompetence, cervical encirclage, trans vaginal scan
Description
1,2Department of Gynecology & Obstetrics, Kathmandu University Hospital, Kavre, Nepal.