A Randomized Comparative Study between Second Trimester Cervical Cerclage and Observational Management on Duration of Pregnancy and Perinatal Outcome

Abstract

Background: Cervical cerclage is a commonly performed intervention in the care of women at risk of preterm birth or second-trimester fetal loss to prevent preterm cervical dilatation. Aim: To compare the second trimester trans-vaginal cervical cerclage with conservative management on duration of pregnancy and perinatal outcome. Materials and Methods: This was a randomized controlled clinical trial that included (40) pregnant females attending El-Shatby Maternity University Hospital antenatal care clinic. All cases of group A were subjected to planned cervical cerclage (McDonald) after the 14 th week of gestation by the same surgeon. All cases of group B were subjected to observational management. Both groups did urinalysis and high vaginal swab to detect and treat infection. All cases were subjected to trans-vaginal ultrasound scans at 14, 16 and 18 weeks then every month till delivery to assess viability, internal os diameter, cervical dilatation and length of the cervical canal. Also the time of delivery, process of labor, complications, and fetal outcome were recorded. Results: There was no statistically significant difference in cervical length measurements between the two groups at the gestational ages of 14, 16, 18 and 36 weeks, while at 24, 28 and 32 weeks gestation, the cervical length was longer in group A than group B and this was statistically significant. Also, no statistically significant difference was found between groups regarding timing, termination mode, specific complications observed during pregnancy and labor. Conclusion : There is no evident role for a second trimester trans-vaginal cervical cerclage over conservative management on the duration of pregnancy and perinatal outcome.