Descriptive Analysis of Cervical Insufficiency in Primigravida: Insights into Cerclage Intervention and Clinical Impact
DOI:
https://doi.org/10.36283/ziun-pjmd14-2/015Keywords:
Cervical insufficiency, Cervical Cerclage, Pregnancy TrimesterAbstract
Background: Cervical incompetence (CI) is a severe obstetric disorder that can result in pregnancy loss in the second trimester and preterm birth. Cervical cerclage is a routinely utilized method for treating CI, however its efficacy in primigravida individuals requires further investigation. This study aimed to find the frequency of cervical incompetence requiring cervical cerclage in patients entering their second trimester.
Methods: This descriptive case series took place at Fatima Memorial Hospital, Lahore, Pakistan, within the six months from June 2024 to January 2025. The study included 160 primigravida individuals to determine the prevalence of cervical incompetence necessitating cerclage in the second trimester and assess delivery outcomes. Data was collected using a standardized questionnaire that included demographics, cervical length, and delivery outcomes. Patients with a cervical length of less than 2.5 cm were diagnosed as having CI and underwent cerclage. Data was analyzed using SPSS version 25.0.
Results: Out of the total subjects, 32 (20%) were diagnosed with CI. Among these, 17 (53.1%) delivered full-term (≥37 weeks), 11 (34.4%) had preterm births (<37 weeks), and 4 (12.5%) miscarried (<24 weeks). All 128 patients without CI had full-term deliveries (100%). The chi-square test revealed a significant difference in full-term delivery rates between patients with and without CI (p < 0.001).
Conclusion: This study discovered a 20% frequency of cervical incompetence among primigravida patients. Cervical cerclage increased the likelihood of full-term delivery; yet, preterm births and losses continued in a sizable number of patients.
References
Han Y, Li M, Ma H, Yang H. Cervical incompetence: a noteworthy disease with controversies. J Perinat Med. 2020 Sep 25;48(7):648-655. doi: 10.1515/jpm-2020-0255.
Reicher L, Fouks Y, Yogev Y. Cervical Assessment for Predicting Preterm Birth-Cervical Length and Beyond. J Clin Med. 2021 Feb 7;10(4):627. doi: 10.3390/jcm10040627.
Cui N, Li X, Wen X, Xu J, Chen L. Pathological Changes and Pregnancy Outcomes in Cervical Intraepithelial Neoplasia Patients After Cold Knife Conization. Int J Gen Med. 2024 Aug 22;17:3641-3648. doi: 10.2147/IJGM.S457614.
Diago Muñoz DM, Martínez-Varea A, Roca Prats A, Alonso-Díaz R, Perales Marín A, Diago Almela VJ. Diagnosis of intraamniotic inflammation by measuring vaginal interleukin-6 in patients with cervical incompetence: could amniocentesis be avoided? J Matern Fetal Neonatal Med. 2022 Dec;35(25):9303-9307. doi: 10.1080/14767058.2022.2029838.
Miller HE, Mayo JA, Reddy RA, Leonard SA, Lee HC, Suharwardy S, et al. Racial and Ethnic Disparities in Cervical incompetence, Cervical Cerclage, and Preterm Birth. J Womens Health (Larchmt). 2025 Jan;34(1):70-77. doi: 10.1089/jwh.2024.0088.
da Fonseca EB, Damião R, Moreira DA. Preterm birth prevention. Best Pract Res Clin Obstet Gynaecol. 2020 Nov;69:40-49. doi: 10.1016/j.bpobgyn.2020.09.003.
Ridout AE, Ross G, Seed PT, Hezelgrave NL, Tribe RM, Shennan AH. Predicting spontaneous preterm birth in asymptomatic high-risk women with cervical cerclage. Ultrasound Obstet Gynecol. 2023 May;61(5):617-623. doi: 10.1002/uog.26161.
Bronshtein M, Blumenfeld Z. Value of transvaginal sonography after cervical cerclage. Ultrasound Obstet Gynecol. 2017 Mar;49(3):419-420. doi: 10.1002/uog.15984.
Ortiz JU, Eixarch E, Micheletti T, Lobmaier SM, Bennasar M, Martinez JM, et al. Impact of Preoperative Cervical Length on Pregnancy Outcome in Twin-Twin Transfusion Syndrome. Z Geburtshilfe Neonatol. 2022 Aug;226(4):245-250. doi: 10.1055/a-1812-5608.
Zhang Y, Zhao Z, Xu J, Wu F, Chen T, Hou S, et al. Cervical length of preoperative cervical cerclage prognostic impacted the effect of cervical incompetence. BMC Pregnancy Childbirth. 2025 Jan 8;25(1):12. doi: 10.1186/s12884-025-07142-w.
Freegard GD, Donadono V, Impey LWM. Emergency cervical cerclage in twin and singleton pregnancies with 0-mm cervical length or prolapsed membranes. Acta Obstet Gynecol Scand. 2021 Nov;100(11):2003-2008. doi: 10.1111/aogs.14255.
Wierzchowska-Opoka M, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B. Emergency Cervical Cerclage. J Clin Med. 2021 Mar 18;10(6):1270. doi: 10.3390/jcm10061270.
Su J, Li D, Yang Y, Cao Y, Yin Z. Cerclage placement in twin pregnancies with cervical dilation: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2022 Dec;35(25):9112-9118. doi: 10.1080/14767058.2021.2015577.
Pilarski N, Bhogal G, Hamer J, Man R, Morris RK, Hodgetts-Morton V. Interventions for women with premature cervical dilatation and exposed fetal membranes to prevent pregnancy loss and preterm birth - A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2024 Sep;300:278-286. doi: 10.1016/j.ejogrb.2024.07.022.
Tajeran G, Derakhshan R, Jayervand F, Rahimi M, Hajari P, Hashemi N. The predictive value of transvaginal cervical length and cervical angle ultrasonography in term delivery outcomes: a cohort study. J Matern Fetal Neonatal Med. 2024 Dec;37(1):2406344. doi: 10.1080/14767058.2024.2406344.
Kulinskaya E, Dollinger MB. An accurate test for homogeneity of odds ratios based on Cochran's Q-statistic. BMC Med Res Methodol. 2015 Jun 10;15:49. doi: 10.1186/s12874-015-0034-x.
Barinov SV, Artymuk NV, Novikova ON, Shamina IV, Tirskaya YI, Belinina AA, et al. Analysis of risk factors and predictors of pregnancy loss and strategies for the management of cervical insufficiency in pregnant women at a high risk of preterm birth. J Matern Fetal Neonatal Med. 2021 Jul;34(13):2071-2079. doi: 10.1080/14767058.2019.1656195.
Paljk I, Blickstein I, Bregar M, Trojner-Bregar A. Cervical cerclage after prior uterine and cervical surgery. J Matern Fetal Neonatal Med. 2022 Dec;35(25):7360-7362. doi: 10.1080/14767058.2021.1949275.
Aubin AM, McAuliffe L, Williams K, Issah A, Diacci R, McAuliffe JE, et al. Combined vaginal progesterone and cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis. Am J Obstet Gynecol MFM. 2023 Aug;5(8):101024. doi: 10.1016/j.ajogmf.2023.101024.
Cassardo O, Scarrone M, Perugino G, Di Maso M, Wally Ossola M, Ferrazzi E, et al. Predictors of preterm birth following emergency and ultrasound-indicated cervical cerclage: A retrospective study on 136 singleton pregnancies. Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:249-253. doi: 10.1016/j.ejogrb.2024.09.011.
Buijtendijk MF, Bet BB, Leeflang MM, Shah H, Reuvekamp T, Goring T, et al. Diagnostic accuracy of ultrasound screening for fetal structural abnormalities during the first and second trimester of pregnancy in low-risk and unselected populations. Cochrane Database Syst Rev. 2024 May 9;5(5):CD014715. doi: 10.1002/14651858.CD014715.pub2.
Medjedovic E, Begic Z, Suljevic A, Muftic A, Dzihic E, Kurjak A. Amnioreduction in Emergency Rescue Cervical Cerclage with Bulging Membranes. Med Arch. 2020 Apr;74(2):151-152. doi: 10.5455/medarh.2020.74.151-152.
Wierzchowska-Opoka M, Kimber-Trojnar Ż, Leszczyńska-Gorzelak B. Emergency Cervical Cerclage. J Clin Med. 2021 Mar 18;10(6):1270. doi: 10.3390/jcm10061270.
Kornete A, Volozonoka L, Zolovs M, Rota A, Kempa I, Gailite L, et al. Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges. Medicina (Kaunas). 2023 Mar 26;59(4):653. doi: 10.3390/medicina59040653.
Bruno AM, Benson AE, Metz TD, Blue NR. Adjunct Therapy at Time of Examination-Indicated Cervical Cerclage in Singleton Pregnancies: A Systematic Review and Meta-analysis. Am J Perinatol. 2022 Dec;39(16):1719-1725. doi: 10.1055/a-1877-9078.
Zhuang Y, Li H, Na Q, Yin S, Li N. Prevention of Preterm Birth by Cervical Pessary Combined with Vaginal Progesterone: A Systematic Review and Meta-analysis with Trial Sequential Analysis. Reprod Sci. 2023 Jan;30(1):93-110. doi: 10.1007/s43032-022-00926-
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