To Do Or “Knot” to Do – Evaluation of Cervical Cerclage Outcomes Based on Indication and Technique: A Retrospective Tertiary Care Study

Aim and background: Cervical insufficiency refers to the inability of the uterine cervix to retain the pregnancy in the second trimester, in the absence of uterine contractions.It affects 1 in 100 pregnancies and accounts for 25% of second-trimester pregnancy loss.It may be associated with symptoms only during the process of expulsion.It is distressing to the patient and poses a challenge to the obstetrician, especially with a prevailing uncertainty regarding the use of progesterone.Diagnosis and timely management are essential.Cervical cerclage is a procedure that helps to save and sustain the pregnancy when performed on ideal cases.It can be detrimental when performed with no clear indication.Materials and methods: This retrospective observational study included all patients who satisfied the inclusion criteria and underwent cervical cerclage between May 2020 and May 2023 and terminated pregnancy at our center.Data were collected from the Institution's Electronic Medical Records.Patients were categorized into three groups: History-indicated cerclage group, ultrasound (USG)-indicated cerclage group, and emergency cerclage group.The evaluated outcomes were the period of gestation from cerclage insertion to delivery, gestational age at delivery, birth weight, and neonatal outcome.Results: Sixty-nine patients were included in the study.The mean patient age was 27 3.99.Around 58% of patients were multigravidas, of which 72.5% were nulliparas.The mean cervical length was 2.00 0.7 cm.The mean gestational age at the time of cervical cerclage was 18 weeks + 6 days 4 weeks + 2 days.Thirty patients had cervical dilation (<4 cm).Around 37.7% were USG indicated, and 34.8% were emergency cerclage.Around 69.6% were done by McDonald's method.The mean gestational age at delivery was 33 weeks + 2 days 6 weeks + 3 days.The mean time from cerclage insertion to delivery was 14 weeks + 3 days 6 weeks + 6 days.Average birth weight was 2.18 1.06 kg.Thirteen pregnancies were terminated before 28 weeks.Of the rest, 54.6% were preterm deliveries.Around 51% of the preterm deliveries were Very Preterm.Around 25% had preterm prelabor rupture of membrane (PROM), and 23.2% had preterm labor contractions.Around 84% were live birth.Seven patients had cervical tears.Conclusion: Cervical cerclage is a useful tool to salvage and prolong an otherwise short-lived pregnancy with an adverse outcome.Patient selection is important.