Open Access Open Access  Restricted Access Subscription or Fee Access

Use of Cervical Cerclage as a Treatment Option for Cervical Incompetence: Patient Characteristics, Presentation and Management over a 9 Year Period in a Kenyan Centre

Paul B. Karau, Mwikamba G. Mutwiri1, Julius A. Ogeng’o, Geoffrey M. Karau

Abstract

Treatment of cervical incompetence by cerclage and other methods has yet to be standardized, as its diagnosis is not uniformly accepted. Its diagnosis, particularly in the African setting, is mostly based on past obstetric history of pregnancy losses, while in developed centres; ultrasound diagnosis is increasingly being used. The mainstay of treatment in developing countries is cervical cerclage, although the indications and contraindications of this mode of treatment are not documented. Our aim was to appraise this practice in terms of patient characteristics, the diagnostic process and management at the Kenyatta National Hospital, Nairobi, Kenya. This was a descriptive retrospective study over 9 years. Predesigned questionnaires were employed to collect data on patient’s socio-demographic profile, presentation, risk factors, diagnosis and management of cervical incompetence. Chisquared test and student’s t-test were used to correlate variables. A total of 199 patients were treated for cervical incompetence, with the patient mean age being 27.97. 87.4% of the patients (p=0.02) were in the 20 to 35 years category. Most of the patients (60.1%) were of low socio-economic status. Cervical cerclage was employed in all the patients, although ultrasound investigation was not employed in 65.8% of them. Diagnosis of cervical incompetence still relies on history of previous pregnancy losses, with the standard transvaginal ultrasound relatively unemployed. There is need to intensify investigations for this condition, standardize the indications for cerclage, and diversify management to other newer modalities.  (Afr J Reprod Health 2013; 17[1]: 169-173).

Résumé

Le traitement de l’insuffisance  cervicale par le cerclage n'a pas encore été standardisé, étant donné que son diagnostic n'est pas uniformément accepté. Son diagnostic en Afrique, est principalement basé sur les antécédents obstétricaux de pertes de grossesse, alors que dans les centres développés, le diagnostic échographique est utilisé. Notre objectif était d'évaluer cette pratique en termes de caractéristiques des patientes, le processus de diagnostic et de gestion à l'Hôpital National Kenyatta, à Nairobi, au Kenya. Il s'agissait d'une étude rétrospective descriptive qui a duré 9 ans. Les questionnaires préconçus ont été utilisés pour recueillir des données sur la situation sociodémographique des patientes, la présentation, les facteurs de risque, le diagnostic et la gestion d'insuffisance cervicale. Le Test du chi carré et le test de  t de l’étudiant ont été utilisés pour corréler les variables. Un total de 199 patientes ont été traitées pour l’insuffisance cervicale, l'âge moyen des patientes étant de 27,97. 87,4% des patientes (p = 0,02) se trouvaient dans la catégorie des 20 à 35 ans. La plupart des patientes (60,1%) étaient de faible statut socioéconomique. Le cerclage du col utérin a été utilisé chez toutes les patientes, bien qu’on n’ait pas mené une enquête échographique auprès des 65,8% d'entre elles. Le diagnostic d'insuffisance cervicale repose toujours sur les antécédents de perte de grossesses précédentes, là où on n’a presque pas utilisé l'échographie trans-vaginale normale. Il est nécessaire d'intensifier les recherches pour cette situation, de standardiser les indications du cerclage, et de diversifier la gestion vers d'autres modalités nouvelles.  (Afr J Reprod Health 2013; 17[1]: 169-173).

 

Keywords: Cervical incompetence, cerclage, diagnosis, management 

Full Text:

PDF

References

Althuisius SM, Dekker GA, Hummel P, Bekedam, DJ, Kuik D, Van Geijn, HP. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length. Ultrasound in Obstetrics and Gynecology, 2002; 20 (2):163-167

Grant A. Cervical cerclage to prolong pregnancy. In: Chalmers I, Enkin M, Keirse MJ (eds). Effective Care in Pregnancy and Childbirth. Oxford: Oxford University Press, 1989; 633–646.

Aarts JM, Brons JTJ, Bruinse HW. Emergency cerclage: A review. Obstet Gynecol Surv 1995; 50:459–69

Guzman ER, Houlihan C, Vintzileos A. The significance of Transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage. Am J. Obstet Gynecol, 1998; 175, 471-6

Cardosi RJ, Chez RA. Comparison of elective and empiric cerclage and the role of emergency cerclage. J Matern Fetal Med.1998; 7: 230–234.

Idrisa A, Kyari O, Ojiyi E. Pregnancy complications and outcome following cervical cerclage operations at the University of Maiduguri Teaching Hospital. Nig J

Clinical Practice, 2002 Vol.5 (1): 25-28

Rust OA, Atlas RO, Jones KJ, Benham BN, Balducci J. A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected secondtrimester preterm dilatation of the internal os. Am J Obstet Gynecol, 2000; 183: 830–835.

Althuisius, SM, Dekker, GA. Controversies regarding cervical incompetence, short cervix, and the need for cerclage. Clinics in Perinatology, 2004; 31 (4):695-

Shane P; Kornman L H; Bell R J; Brennecke S P. Cervical surveillance as an alternative to elective cervical cerclage for pregnancy management of suspected cervical incompetence. The Australian & New Zealand journal of obstetrics & gynaecology 2004; 44(3):228-32.

Marek S. Non-surgical management of cervical incompetence by vaginal pessary installation. Archives of Perinatal Medicine, 2002; 8(4), 22-24.

Fox R, James M, Tuohy J, Wardle P. Transvaginal ultrasound in the management of women with suspected cervical incompetence. Br J Obstet Gynaecol. 1996; 103: 921–924.

Heath VCF, Southall TR, Souka AP, Elisseou A & Nicolaides KH. Cervical length at 23 weeks of gestation: prediction of spontaneous preterm delivery. Ultrasound in Obstetrics and Gynecology, 1998, 12: 312-317.

PRAMS. Pregnancy Risk Assessment Monitoring System, Florida, 2002.

Lieberman E, Ryan KJ, Monson RR & Schoenbaym SC. Risk Braz J Med Biol Res 37(5) Risk factors accounting for racial differences in the rate of premature birth. New England Journal of Medicine, 1987; 317: 743-748.

Owen J, Goldenberg RL, Davi RO, Kirk KA & Copper RL. Evaluation of a risk scoring system as a predictor of preterm birth in an indigent population. American Journal of Obstetrics and Gynecology, 1990; 163: 873-879.

Palma-Dias RS, Fonseca MM, Stein NR, Schmidt AP, Magalhães JA. Relation of cervical length at 22-24 weeks of gestation to demographic characteristics and obstetric history. Braz J Med Biol Res, 2004, Volume 37(5) 737-744

Zuckerman BS, Walker DK, Frank DA, Chase C & Hamburg B. Adolescent pregnancy: biobehavioural determinants of outcome. Journal of Pediatrics, 1984; 105: 857-862.

Heffner LJ, Sherman CB, Speizer FE & Weiss ST. Clinical and environmental predictors of preterm labor. Obstetrics and Gynecology, 1993; 81: 750-757

Refbacks

  • There are currently no refbacks.