Cervical Incompetence and Outcomes of Management at A Secondary Health Facility in Nigeria

Abstract

Background: Cervical incompetence (CI) is a common cause of recurrent mid-trimester pregnancy loss and preterm deliveries. Incompetence of the cervix is associated with fetal loss, perinatal morbidity and mortality; psychological and social stress for the affected woman. 

Objective: To describe the clinical presentation, management of cervical incompetence and outcomes of pregnancy at a secondary healthcare facility. 

Materials and Methods: A retrospective review conducted at Adeoyo Maternity Hospital among pregnant women who had cervical cerclage for treatment of cervical incompetence over a five-year period. There were 50 cases of cervical incompetence and medical records of 45 women treated by cervical cerclage were reviewed. The data collected included- socio-demographic, obstetric and clinical characteristics; and management. Data was analysed using IBM SPSS software version 23 and level of significance was p=<0.05.

Result: Total number of deliveries over the five-year period was 12,845 and 50 women had cervical incompetence and cerclage, giving a CI prevalence of 0.39%. Mean age was 32.16± 4.35years, majority 33(73.3%) had ≥ 3 miscarriages. Mean gestational age (GA) at presentation was 12.4 ± 3.54 weeks and at insertion of cervical stitch was at 14.7± 1.14 weeks. Mc Donald cervical cerclage was done; 41(91.1%) and 4(8.9%) had elective and emergency cerclage respectively. Overall, 34 (75.6%) had successful vaginal delivery of live babies; mean GA at delivery was 34.4±6.67weeks. Removal of cerclage-to-delivery interval was 1.0±1.23weeks. The fetal salvage rate was 71.1%. 

Conclusion: Cervical cerclage for CI is beneficial in the prevention of fetal wastage and gives hope to women with cervical incompetence. CI, pregnancy loss and preterm delivery are associated with psychosocial effects especially in environments where much premium is placed on child bearing. Early identification and management of CI is important to prevent pregnancy loss and complications.