Effectiveness of Double Cervical Cerclage in Women with at Least One Previous Pregnancy Loss in the Second Trimester

Abstract

Background: Recurrent pregnancy failure in second trimester is defined as three or more losses although most authors consider clinical treatment with 2 consecutive miscarriages at 14-18 weeks of gestation. Preterm births are more likely to occur in future pregnancies for women who have previously experienced cervical incompetence. Objective: The study's objective was to determine whether double cervical cerclage had any impact on perinatal outcomes and preterm delivery prevention in women who had experienced second-trimester foetal loss. Materials and Methods: This interventional prospective randomized controlled study included patients who attended the Outpatient Clinic with suspected cervical incompetence either by previous obstetric history or by ultrasound examination with gestational age between 14 and 18 weeks. The patients were randomly allocated into 2 groups; group 1 included 20 patients who had traditional modified MacDonald operation using a 5 mm mersilene tape in the middle third of the cervix and group 2 included 20 matched patients who had double cervical cerclage with two purse-string sutures using two 5 mm mersilene tapes; in the upper and lower third of the cervix. Results: There was no significant difference between the double cervical and single cervical group regarding weight of the baby at birth, GA at delivery, abortion, mode of delivery and admission of baby to NICU. There was no significnat difference between both groups regarding hematuria, hospital stay (hours) and neonatal death after operation ( p > 0.05 ). Conclusion : Women with cervical incompetence who undergo double cervical cerclage do not experience better perinatal or maternal outcomes.