Review of the contemporary use of transvaginal cervical cerclage for the prevention of preterm birth at Tygerberg Hospital

Kayambo, Doris (2017-12)

Thesis (MMed)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: Aim: The main aim of this study was to review the contemporary use of transvaginal cervical cerclage. Methods: This retrospective observational study was done at Tygerberg Academic Hospital (TBH), a secondary and tertiary referral centre in the Western Cape Province. It included all pregnancies in whom a transvaginal cervical cerclage was placed from 1 Jan 2009 to 31 Dec 2014. Cervical cerclage was deemed successful if pregnancy was carried beyond 28 weeks of gestation. Results: 140 transvaginal cerclages were identified for analysis, which consisted of 80 history indicated (HI), 51 ultrasound indicated (UI) and 9 clinical indicated (CI) cerclages. An overall success rate of 74.3% was noted, with individual success rates of 81.3% and 76.5% in the HI and UI groups respectively. All CI cerclages delivered before 28 weeks. The overall live born rate after 24 weeks gestation was 78.6%; 85.0% in the HI group, 76.5% in the UI group and 22.2% in the CI group. The preterm birth (PTB) rate <34 weeks was 42.6% and 33.3% in the HI and UI groups. Cerclage related complications, specifically perioperative rupture of membranes (1.4%), cervical tears (2.1%) and suture displacement (5.0%) were infrequently seen, while preterm rupture of membranes at any gestation was encountered in 22.1% of all cases. Conclusion: Cervical cerclage remains one of the key preventative measures in prevention of PTB especially in high risk populations. Our data highlights the diversity of patients at risk of PTB and the complexities involved in their care. This study sheds light on the need for correct identification of suitable women for cervical cerclage insertion in a developing country setting.

AFRIKAANS OPSOMMING: Doel: Die hoofdoel van hierdie studie was om die kontemporêre gebruik van transvaginale servikale steek te hersien. Metodes: Hierdie retrospektiewe waarnemingstudie is by Tygerberg Akademiese Hospitaal (TBH), 'n sekondêre en tersiêre verwysingsentrum in die Wes-Kaapprovinsie, gedoen. Alle swangerskappe is ingesluit in wie 'n transvaginale servikale steek van 1 Januarie 2009 tot 31 Desember 2014 geplaas was. ʼn Servikale steek is as suksesvol beskou as die swangerskap verby 28 weke volhou. Resultate: 140 transvaginale steke is geïdentifiseer vir analise, wat saamgestel is uit 80 geskiedenis aangeduide (HI), 51 ultraklank aangeduide (UI) en 9 klinies aangeduide (CI) steke. Die algehele sukseskoers van 74.3% was waargeneem, met individuele sukseskoerse van onderskeidelik 81,3% en 76,5% in die HI- en UI-groepe. Al die CI steke is voor 28 weke verlos. Die algehele lewendige geboortekoers, na 24 weke, was 78,6%, 85,0% in die HI-groep, 76,5% in die UI-groep en 22,2% in die CI-groep. Die voortydige kraam (PTB)-koers <34 weke, was 42,6% en 33,3% in die HI- en UI-groepe. Steek-verwante komplikasies, spesifiek peri-operatiewe ruptuur van membrane (1.4%), servikale skeure (2.1%) en steek verplasing (5.0%) was selde gesien terwyl premature ruptuur van membrane by enige swangerskapsduur voorkom in 22.1% van alle gevalle. Gevolgtrekking: Servikale steke bly een van die belangrikste voorkomende maatreëls in die voorkoming van PTB, veral in hoërisiko-bevolkings. Ons data beklemtoon die omvang van pasiënte wat ʼn risiko het vir PTB en die kompleksiteite wat by hul sorg betrokke is. Hierdie studie beklemtoon die behoefte aan korrekte identifisering van geskikte vroue vir servikale steke in 'n ontwikkelende land omgewing.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102958
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