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A 10-year review of the maternal and neonatal outcomes in patients with history-indicated, ultrasound-indicated and rescue cervical cerclages; a retrospective study.
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  • Premikha M,
  • Karen Lim,
  • Arundhati Gosavi,
  • Jason Sam Leo,
  • Arijit Biswas
Premikha M
MOHH

Corresponding Author:[email protected]

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Karen Lim
National University Hospital
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Arundhati Gosavi
National University Hospital
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Jason Sam Leo
National University Singapore Saw Swee Hock School of Public Health
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Arijit Biswas
National University Hospital
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Abstract

Objective: To assess differences in cervical cerclage success rates, maternal and neonatal outcomes in patients with history-indicated, ultrasound-indicated and rescue cerclages, and identify factors associated with these differences. Design: A retrospective study of patients with cervical cerclages between January 2008 and October 2017 at National University Hospital, Singapore was performed. Method: Patients’ data was extracted from electronic health records and analysed. 163 cerclages were inserted; 14 patients were lost-to-follow-up and excluded. Results: The details of 149 cerclages were analysed (history-indicated, n=83, ultrasound-indicated, n=39, and rescue cerclages, n=27). Patients with rescue cerclages had the lowest cerclage success rate of 55.56%, defined as pregnancies continuing beyond 24 weeks. Patients with history-indicated and ultrasound-indicated cerclages had similarly high success rates of 91.57% and 92.31% respectively. Rescue cerclages, twin pregnancies, larger cervical dilation at presentation, pre-existing type 2 diabetes mellitus and Indian ethnicity were significantly associated with cerclage failure. Patients with rescue cerclages had the highest proportion of patients with one or more maternal complications, and highest rates of preterm premature rupture of membranes and preterm labour. Patients with rescue cerclages also had the lowest neonatal survival rate, lowest mean birth weight and highest proportion of neonatal complications i.e. respiratory distress syndrome, intraventricular haemorrhage, necrotising enterocolitis, and hypoxic-ischemic encephalopathy. Conclusion: Maternal and neonatal outcomes are significantly poorer in women with rescue cerclages, compared to patients with history-indicated and ultrasound-indicated cerclages. Appropriate assessment of risk factors for cervical incompetence and serial cervical length monitoring may reduce rescue cerclages, which may improve outcomes.