Pregnancy Outcomes of Patients with Ultrasound-indicated and History-indicated McDonald Cervical Cerclage

Objective: To assess pregnancy outcomes of patients with ultrasound-indicated and history-indicated McDonald cervical cerclage. Materials and methods: This was a cross-sectional study of pregnant women who had cervical cerclage performed at Aga Khan University Hospital, Karimabad campus. We obtained Institutional Review Board approval and reviewed the medical records of patients. A purposive continuous sampling technique was used. A total of 88 patients were included. There were no exclusion criteria. Outcome data were collected from the medical record of patients from January 2010 to December 2016. Results: Analysis reported a statistically significant lower gravidity and parity in the scan-indicated group as compared with other groups (p = 0.000 and p = 0.001, respectively). Previous history of cervical cerclage, history of mid-trimester miscarriage, and preterm labor were significantly associated with indication for cerclage (p = 0.001, 0.046, and 0.001, respectively). Cervical length was also significantly associated with the indication for cerclage (p <0.001). Lower gestational age at previous abortion in the history-indicated group as compared with other groups (p = 0.003 and <0.001, respectively). Pregnancy prolongation was significantly lower in the scan-indicated group as compared with other groups (p = 0.04 and 0.004, respectively). Conclusion: Our study showed that patients with a history suggestive of cervical incompetence or short cervix on ultrasound should be offered cerclage to prevent preterm birth and to improve neonatal outcomes. Ultrasound-indicated cerclage after the first trimester indicates that universal cervical-length screening by transvaginal ultrasound in the mid-trimester can pick silent cases, and inserting cerclage can prolong pregnancy to term. Clinical significance: Screening cervical length will help clinicians to reduce preterm birth rate, especially in resource-limited underdeveloped countries.