Transabdominal cerclage in women with cervical incompetence could improve the neonatal survival rate of a singleton and a twin up to 91 percent and 94 percent, respectively, local researchers said in a study. Such findings were the first of its kind in the world, they said.
Cervical incompetence is a medical condition of pregnancy in which the cervix begins to efface before it has reached term. It can cause premature birth and miscarriage.
When diagnosed with cervical weakness, a patient receives medication and transvaginal cerclage to prevent preterm birth and treat it.
Transvaginal cerclage, or inserting a speculum into the patient’s vagina and grasp the cervix with ring forceps, is known as a procedure for general cervical incompetence. However, a failed transvaginal cerclage may lead to premature birth.
To prevent this, the patient needs transabdominal cerclage, which is to take out the uterus and the fetus and tie the cervix through the amniotic membrane and blood vessels. The operation could be very demanding for medical staff because the fetus could die if there is too much bleeding or if the amniotic membrane ruptures.
The clinical guidelines for obstetrics and gynecology recommend transabdominal cerclage in singleton pregnancy only. No clinical guidelines have been reported in twin pregnancy.
The research team, led by Professor Lee Keun-young at the Obstetrics and Gynecology Department of Kangnam Sacred Heart Hospital, analyzed 165 women (146 with singletons and 19 with twins) with cervical incompetence who underwent transabdominal cerclage from January 2007 to June 2018 at the hospital.
The women previously received transvaginal cerclage but had preterm births. In the next pregnancy, however, they prevented preterm births by transabdominal cerclage and achieved full-term labor.
The research team compared how much difference the prenatal survival rates could be when performing transvaginal cerclage versus transabdominal cerclage. Also, the team evaluated if transabdominal cerclage after a failed transvaginal cerclage could be effective for women pregnant with twins.
The results showed that transabdominal cerclage significantly raised the neonatal survival rate of singletons from 22.8 percent to 91.1 percent, and that of twins from 15.4 percent to 94 percent.
The researchers also found that transabdominal cerclage was effective for women in twins pregnancy.
The study was published in the May copy of Plos One with the title, “Outcomes after transabdominal cerclage in twin pregnancy with previous unsuccessful transvaginal cerclage.”
“This is the world’s first study that compared survival rates of singletons and twins in women who received transabdominal cerclage after a failed transvaginal cerclage,” Professor Lee said.
The research could serve as a basis for transabdominal cerclage for those in twins pregnancy whose previous transvaginal cerclage failed, and become a part of clinical guidelines for obstetrics and gynecology.
Hallym University Kangnam Sacred Hospital said the hospital had performed over 4,000 cervical cerclage, including 500 transabdominal cerclage, which is the most in the world as a single medical institution.