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  • Title: Cervical cerclage in the treatment of cervical incompetence in Zambian women.
    Author: Waloch M.
    Journal: Clin Exp Obstet Gynecol; 1996; 23(4):255-62. PubMed ID: 9001790.
    Abstract:
    Over a period of 5 years from January 1989 to October 1994, 207 patients with cervical incompetence were managed with Mac Donald's cervical cerclage at Nkana/Wusikili Mine Hospitals, Kitwe, Zambia. The incidence rate of cervical incompetence in our population was 1.47%. Our results confirmed a success rate of 90.8% as compared to 52.5% in previous pregnancies. This represents 159 (76.8%) full term pregnancies, 29 (14%) premature deliveries and 19 (9.2%) abortions. Post operation total survival rate was 87.4% with fetal salvage ratio of 1.68. We confirmed that optimum time to insert cerclage was 18 weeks and below. The possibility of having a mature baby in the group of low number previous abortions was significantly higher as compared to the group with a higher number of habitual abortions. Better pregnancy outcome was seen in low parity group (less than 2 previous deliveries) as compared to higher parity group. Our study confirms that cervical cerclage is a successful way in the treatment of cervical incompetence. A prospective study conducted among 207 pregnant women at Nkana and Wusikili Mine Hospitals in Kitwe, Zambia, during 1989-94 indicated that McDonald's cervical cerclage is effective in the treatment of cervical incompetence. All patients had a history of 2 or more midtrimester spontaneous abortions with indications of cervical incompetence. Cervical cerclage was performed before 18 weeks of gestation in 129 women (62%) and at 18 weeks or later in the remaining 78 women (38%). Cerclage sutures were removed at 35-36 weeks' gestation or whenever labor became established. The overall success rate was 90.8%, including 159 full-term pregnancies (76.8%), 29 premature deliveries (14%), and 19 abortions (9.2%). Mean gestational age at delivery was 34.5 +or- 10.9 weeks. There were significantly more abortions in the group of women who had cerclage performed before 18 weeks compared with those who had the procedure at a later point in pregnancy (13.1% versus 2.5%, respectively). The post-cerclage survival rate was 87.4% and the overall fetal salvage ratio was 1.68. The most frequent complications were uterine contractions and rupture of the membranes. These findings confirm earlier recommendations that cervical cerclage is most effective when performed at 20-24 weeks' gestation.
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