Clinical outcome of modified McDonald's procedure for the treatment of pregnancies with cervical insufficiency

Objective To investigate the clinical outcome of modified McDonald's procedure for the treatment of pregnant women with cervical insufficiency. Methods Clinical data of 113 women with singleton pregnancies with cervical insufficiency who underwent negative low cervical cerclage in the Sixth Affiliated Hospital of South China University of Technology from January 2012 to December 2022 were retrospectively analyzed. They were categorized into prophylactic cervical cerclage group （<i>n = </i>23） and therapeutic cervical cerclage group （<i>n = </i>90） according to the purpose of the procedure. The general status， pregnancy outcome， postoperative complications and neonatal status in two groups were recorded. Multivariate Logistic regression analysis was carried out with whether therapeutic cervical cerclage yielded poor prognosis （abortion） as the dependent variable. Results In the prophylactic cervical cerclage group， the number of pregnancy was higher， the gestational week was shorter， the proportions of women with a history of ≥2 previous mid-pregnancy miscarriages or preterm deliveries and intrauterine infection were higher than those in the therapeutic cervical cerclage group （all <i>P &lt; </i>0.05）. The differences were not statistically significant in post-operative comorbidities， neonatal birth quality， and 1-min neonatal Apgar scores between two groups （all <i>P &gt; </i>0.05）. Univariate analysis showed that cervical dilatation and urinary tract infection exerted certain effects on the pregnancy outcome of pregnant women in the therapeutic cervical cerclage group （both <i>P &lt;</i>0.05）. Multivariate Logistic regression analysis demonstrated that cervical dilatation and urinary tract infection were the influencing factors for poor prognosis of pregnant women undergoing therapeutic cervical cerclage （both <i>P &lt; </i>0.05）. Conclusions Dilatation of the cervix and urinary tract infection are the main risk factors affecting the outcome of therapeutic cervical cerclage. For these pregnant women， early monitoring of the cervical condition， prompt treatment of urinary tract infection， and timely cervical cerclage can improve the outcome of mothers and neonates.