Retrospective analysis of cervical cerclage cases performed in our hospital in the last fifteen years and the effect of cervical cerclage procedure on obstetric outcomes

OBJECTIVE: The aim of this study is to retrospectively analyze the results of cervical cerclage procedures performed in our hospital in the last 15 years and to reveal the effect of the cerclage procedure on obstetric outcomes. As a primary result it is planned to evaluate how long the gestational week is prolonged and whether premature rupture of membranes (PROM) and/or premature birth threat develops, the birth weight of the patients and APGAR scores as secondary result. PATİENTS AND METHOD: Patients who underwent cervical cerclage procedure in Ondokuz Mayıs University Faculty of Medicine, Department of Obstetrics and Gynecology between January/2007-December/2021 were included in our study. Patients who underwent emergency cerclage operation, patients who underwent abdominal cerclage, patients who have multiple pregnancies and patients with fetal anomaly were not included in the study. Patients were evaluated according to age, demographic characteristics, obstetric characteristics, cervical examination findings and pregnancy results through the system. The data were compared statistically and the results were evaluated with statistical analysis. RESULTS: Patients who underwent cervical cerclage procedure between January 2007 and December 2021, aged 19-44, were included in the study. Cerclage procedure can be performed with 3 indications obstetric history-based diagnosis, ultrasound-based diagnosis, or physical examination-based diagnosis (also called rescue or emergency cerclage) . 48 of 235 patients who underwent cerclage were not included to the study due to exclusion criteria, and 187 patients were included in our study. All patients included in the study underwent cerclage with the McDonald technique. These patients were divided into 2 groups as those who underwent cervical seclage procedure based on obstetric history and those who underwent ultrasound-based cervical cerclage procedure. There were 104 patients (55.6%) in the history-based cervical cerclage group and 83 patients (44.3%) in the ultrasonography-based cervical cerclage group.In the whole group, 52.4% (n: 98) of the patients gave birth over 37 weeks, 16.6% (n: 31) between 34 and 37 weeks, and 31% (n: 58) under 34 weeks. The mean week of delivery was 33.1 weeks in the history-based cervical cerclage group , and it was 33.9 weeks in the ultrasonography-based cervical cerclage group and difference was not statistically significant. In the group that underwent history-based cervical cerclage, 27.9% (n:29) premature rupture of membranes (PROM), 10.6% (n:11) threatened premature birth and 19.2% (n:20) abortion developed, ultrasonography-based cervical cerclage 28.9% (n:24) early membrane rupture (PROM), 14.5% (n:12) threatened premature birth and 13.3% (n:11) abortion developed in the group that underwent the procedure, no statistically significant difference was found. In our study, the success rate was accepted as reaching the 34th gestational week and the baby being born in a healthy way. The success rate was 68.3% (n:71) in the history-based cervical cerclage group and 69.9% (n:58) in the ultrasonography-based cervical cerclage group, no statistically significant difference was found. There was no significant difference between the birth weight and APGAR scores of the babies. CONCLUSION: Obstetric history-based cerclage is the most successful cerclage procedure among all cerclage procedures. As a result, in our study, in which we examined the 15-year data of our hospital and the results of the cervical cerclage procedures, a different perspective was found from other studies. In previous studies, it was reported that history-based cerclage procedures were more relative than ultrasonography-based cerclage procedures and therefore included bias. However, we found that the success and failure rates of history-based cerclage and ultrasonography-based cerclage procedures were similar. For this reason, our study contributed to the literature, although the number of patients was small, since these two indications have not been compared in the literature before. Keywords: Preterm birth, cervical insufficiency, cervical cerclage, history-based cerclage, ultrasonography-based cerclage