Indications and outcomes of McDonald cerclage in singleton pregnancy

Abstract

Cervical insufficiency is one of the major causes of preterm birth. It accounts for 1% of the pregnant population. Cervical cerclage prevents preterm birth in singleton pregnancies with controversy around its indications and outcomes. This study was conducted to examine indications and outcomes of McDonald cervical cerclage in women with singleton pregnancy from January 2014 to December 2019 at Pelonomi Hospital in Mangaung district metro of Bloemfontein, South Africa. A retrospective analysis of 22 files of pregnant women who had McDonald cerclage for singleton pregnancy during the study period was carried out. Data were analysed descriptively. Group comparisons by means of t-tests and Chi square statistics at p ≤ 0.05 were undertaken. Outcomes among the three indications of cerclage insertion were determined for (i) perinatal outcome and (ii) duration of pregnancy. A total of 38 McDonald cerclages were inserted, giving prevalence of 0,16%. Of the 31 records received, 22 met inclusion criteria. Nine, eight and five cerclages were history-, ultrasound- and emergency-indicated, respectively. The median gestation age at booking was 194 days. There was no statistical difference in outcomes amongst the groups (p = 0,89, 0,87 and 0,14) in history, ultrasound and emergency indicated cerclages, respectively).Similarly, there was no statistically significant evidence to show that McDonald cerclage preventedpreterm birth in singleton pregnancy in terms of outcomes amongst subgroups used to indicate insertion of cerclage. However, the limited study sample and subgroups, implicates the need for a larger study population and perhaps, a multicentre design, to validate the present findings.