Comparison of Pregnancy Outcomes of Triangular 3-Bites and McDonald Techniques of Cervical Cerclage in Women with Cervical Insufficiency: A Pilot Study

Abstract

Background: Cervical cerclage is the procedure of choice for preventing preterm birth due to cervical insufficiency. Despite the simplicity of the McDonald’s method of cerclage application, it is still technically difficult to take four bites around the cervix before knotting. There is a need to develop a simpler method of cervical cerclage application with similar or improved pregnancy outcomes. Aim: This is to compare the ease/duration of application and pregnancy outcomes of the new triangular three‑bite cervical cerclage technique and McDonald’s technique in women with cervical insufficiency. Patients and Methods: This is a pilot study with 20 participants that met the inclusion criteria. They were randomly grouped into triangular three‑bite method (n = 10) and McDonald’s method (n = 10). The pregnancy outcomes were compared between the groups with the Chi‑square test and student’s t‑test. A P value of <.05 was set as level of significance. Results: The sociodemographic characteristics of the two groups were similar. There was no statistically significant difference between the two groups regarding the pregnancy outcome  spontaneous miscarriage P = 1.00, preterm delivery P = 0.61, and neonatal birthweight P = 0.96). However, the duration of cerclage application (5.98 ± 1.79 minutes vs. 14.25 ± 7.5 minutes; P <.002) and estimated blood loss (29 ± 9.94 mls vs. 48.5 ± 25.82 mls; P = .04) were significantly lower in the triangular three‑bite arm than in the McDonald’s arm. Conclusion: The new triangular three‑bite technique has similar pregnancy outcomes with the conventional McDonald’s technique and has shown a lower duration of procedure and blood loss. Since this is a pilot study, a well‑structured randomized control trial to compare the two methods is recommended.