Outcomes of Cervical Cerclage for Pregnancies at Risk of Cervical Insufficiency in a Nigerian Teaching Hospital.

Background and objectives: Preterm births are leading contributors to neonatal, infant and under-five mortality globally. A significant proportion of mid-trimester pregnancy losses and preterm births are due to cervical insufficiency (CI). Cervical cerclage (CC) remains the mainstay of treatment for CI, but information about the clinical outcomes remains insufficient. This study appraised the perinatal outcome of pregnancies that had CC at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Nigeria.

Methods: In a retrospective study, relevant data of all patients who had CC between January 1, 2011, and December 31, 2021 was extracted using a purpose-designed proforma. The data was analysed using the IBM SPSS® 24.0. Associations between categorical independent variables and outcome variables were compared where applicable, using Chi-square, with level of significance set at <0.05.

Results: One hundred and thirty-five CCs were performed within the study period, at a mean gestational age (GA) of 15.7 ± 4.5weeks. Sixteen pregnancies (11.9%) were complicated by miscarriages at GA <25weeks. Ninety-six women (71.1%) delivered after GA of 34weeks, with an overall mean GA of 34.5 ± 5.9 weeks at delivery. Elective cerclage, cervical dilatation of ≤2cm at CC insertion and singleton pregnancy were significantly associated with delivery at EGA ≥34 weeks. (p=0.037, 0.040 and < 0.011 respectively).

Conclusion: If susceptible pregnant women are identified and CC inserted appropriately, pregnancies that are complicated with CI have about 70% chance of progressing beyond 34weeks. The role of tocolytics and antibiotic therapy as adjunctive treatment for CI however requires further evaluation.