Emergency Cervical Cerclage and Pregnancy Outcomes | Chapter 21 | New Horizons in Medicine and Medical Research Vol. 4

 Cervical incompetence is a major cause of preterm delivery and pregnancy loss in the second trimester. The goal of this trial was to see if emergency cervical cerclage was efficacious and safe in women who had extensive cervical dilatation and foetal membrane bulging. The study comprised 363 women who received emergency cervical cerclage in the middle of their third trimester at Prince Meshari Bin Saud General Hospital in Baljurashi, Saudi Arabia, due to cervix dilatation and protruding membranes. The results of the pregnancy analysis revealed that emergency cerclage placement resulted in the birth of live infants with an 84.49 percent success rate. With a mean gestation of 35.34.7 weeks and a mean birth weight of 2134.69370.37 g, the mean time between cerclage and delivery was 92.1626.62 days. After the operation, no serious maternal problems such as maternal death, hematosepsis, or hysterorrhexis occurred.

The pregnancy outcome and risk variables, such as any presenting symptoms, cervical dilatation, and postoperative white blood cell count, had significant relationships. In women with cervical incompetence, emergency cervical cerclage is beneficial in extending pregnancy and improving newborn outcomes. It should be regarded a realistic alternative for women who are in the middle of their pregnancy and have a dilated cervix.

Author(S) Details

Mohammad Othman
Department of Obstetrics and Gynaecology, Fakeeh College of Medical Sciences, Jeddah, Saudi Arabia.

Basil M. Othman
Al-Rayan Medical College, Madinah, Saudi Arabia.

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Cervical Incompetence and Innovative Method for Re-tightening of Loose Cerclage Sticth (Adinma Procedure) | Chapter 2 | Current Topics in Medicine and Medical Research Vol.2

Background: Cervical incompetence (CI) is a major cause of pregnancy loss and preterm delivery.
The management ususally requires the identification of the causes, through relevant evaluation,
followed by the application of an appropriate treatment modality, usually the insertion of the cervical
cerclage stitch.
Objective: To review cervical incompetence – its evaluation and management and highlights an
innovative method for ret-tightening of loose cerclage stitch (Adinma Procedure).
Methods: This review involves a literature search on the internet in relevant journals, textbooks and
monographs.
Results: The incidence of cervical incompetence in the general obstetrics population ranges from 0.5
- 1%, rising to 8% in women with a history of previous mid-trimester miscarriages. The causes may be
congenital as in Ehlers-Danlos syndrome or Marfan syndrome or acquired from cervical trauma or
intra-amniotic infections. Risk of CI includes recurrent mid-trimester miscarriages; a previous preterm
pre-mature rupture of membranes occurring before 32 weeks of pregnancy; or a previous pregnancy
with cervical length less than 25 mm measured before 27th weeks of gestation; previous history of
cervical trauma; some congenital abnormalities; and polycystic ovary disease. Diagnosis is made from
the assessment of cervical shortening; cervical dilatation in the absence of history of maternal uterine
contractions and mid-trimestral ultrasound measurement of cervical length less than 25mm.
Management usually involve transvaginal cervical cerclage, prophylactic abdominal cerclage when
indicated, and in rare occasions expectant management and the use of vaginal pessaries. Salvage of
cervical cerclage may involve simple re-tightening (Adinma) procedure.
Conclusion: Management of CI involves thorough evaluation to identify the various risk factors and
causes; and the restoration of cervical competence through cervical cerclage procedure. Post
procedure periodic evaluation and re-tightening improves the success of cervical cerclage and overall
ultimate outcome of the pregnancy

Author(s) Details

Adinma, Joseph Ifeanyi Brian-D
Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University and Teaching Hospital, P.M.B. 5025, Nnewi, Anambra State, Nigeria.

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