A ten year review of time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, South-East Nigeria

Abstract

Cervical insufficiency is a recognised cause of third trimester miscarriage and spontaneous preterm births. It is one of the leading causes of neonatal morbidity and mortality. Miscarriage and preterm deliveries due to cervical insufficiency can be prevented by cervical cerclage insertion. The study aimed to determine the time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, south-east Nigeria. A ten year retrospective review of all women who had cervical cerclage inserted for suspected cervical insufficiency at the two tertiary health institutions in Enugu state was done. Their case files were retrieved and relevant data extracted. The mean time interval from cerclage removal at term to spontaneous onset of labour was 12 days. The majority of patients (45.6%) had spontaneous onset of labour at the 2^nd week of cerclage removal. There was no significant difference in the mean time interval from cerclage removal to spontaneous onset of labour between ultrasound indicated group and history indicated group. These findings hopefully may assist in proper counselling and management of women who had cervical cerclage removed at term.

Impact Statement

• What is already known on this subject? Cervical insufficiency is a known cause of mid trimester pregnancy loss and preterm delivery. Preterm babies are at risk of several complications, with high neonatal morbidity and mortality especially in developing world. Cervical cerclage insertion is a recognised surgical treatment for cervical incompetence aimed at preventing preterm births.

• What do the results of this study add? The study shows that removal of cervical cerclage at term does not result in immediate onset of spontaneous labour in women diagnosed to have cervical insufficiency. Notably, a majority of the women had spontaneous onset of labour at the 2^nd weeks of cerclage removal. Only 5.3% of them had spontaneous onset of labour within 48 hours of cerclage removal. This is contrary to the general belief in the region that once cervical cerclage is removed, spontaneous onset of labour results.

• What are the implications of these findings for clinical practice and/or further research? This finding suggests that there is no compelling need for admission into hospital after removal of cerclage as very few of them will have spontaneous onset of labour within 48 hours of cervical cerclage removal.

Keywords:

• Cervical insufficiency
• cervical incompetence
• cervical cerclage
• recurrent miscarriage
• preterm delivery
• Nigeria

Acknowledgement

The authors acknowledge the contribution made by the Matrons in charge of the antenatal and post-natal units of the two study centres; Polyclinic and Uwani medical centre.

Disclosure statement

The authors have no conflict of interest.