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
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).
RésuméLe 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
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