Cervical incompetence: prevalence, socio-demographic and clinical characteristics in Rivers State University Teaching Hospital, Port Harcourt, South-South Nigeria.
Wekere FCC1*, Clement-Wekere GAF2, Nonye-Enyidah EI1
1Department of Obstetrics and Gynaecology, Rivers State University Teaching Hospital, Port Harcourt, Rivers State, Nigeria.
2Department of Paediatrics & Child Health, University of Port Harcourt, Rivers State, Nigeria.
*Correspondence: Dr. Felix CC Wekere; +234 803 549 2898; email@example.com
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Background: The Continuation of pregnancy to period of foetal viability and/or term is highly aﬀected by incompetent cervix. Cervical incompetence is the inability of the cervix to carry pregnancy to term due to structural or functional defect. The global prevalence of cervical incompetence ranges from 2.7- 18.4/1000 births. Cervical cerclage is widely used in its management. There is paucity of literature on the prevalence and treatment op on in our environment. Thus, the aim of this study is to determine the prevalence, socio-demographic, and clinical characteristics of cervical incompetence and its treatment in women of reproductive age attending RSUTH for care.
Objective: To determine the prevalence, socio-demographic and clinical characteristics of cervical incompetence and its treatment.
Materials and Methods: It was a retrospective observational study in which data were extracted from the case ﬁles of the 96 patients diagnosed with cervical incompetence using structured study proforma. Data were sorted, coded and analysed using Statistical Package for Social Sciences (SPSS) version 25.
Result: The prevalence of cervical incompetence in Rivers State University Teaching Hospital is 0.69% or 6.9 per 1000 deliveries. The mean age of the patients was 32.4 SD 3.7, and majority (53.1%) were nulliparous. Most of the patients 47 (49%) had secondary level of education. There were 87 (90.6) elective and 9 (9.4%) emergency cases of cerclage insertion. The commonest type of anaesthesia used was regional (subarachnoid block) 89 (92.7%). All the patients had MacDonald procedure with mersilene tape. The mean gestational age and duration of cerclage insertion was 15.2 weeks (95% CI, 14.8 to 15.6) and 15.1 minutes (95% CI, 13.1 to 17.1) respectively.
Conclusion: Cervical incompetence is not uncommon in our region. Cervical cerclage placement is beneﬁcial in managing cervical incompetence. The duration of the procedure is short with minimal blood loss.
Keywords: Cervical incompetence, Cervical cerclage, Prevalence, RSUTH, South –South.
Cite this article: Wekere FCC, Clement-Wekere GAF, Nonye-Enyidah EI. Cervical incompetence: prevalence, socio-demographic and clinical characteristics in Rivers State University Teaching Hospital, Port Harcourt, South-South Nigeria. Yen Med J. 2020;2(1):127-134.
- Dimejesi IBO, Onwe, AB. Cervical Incompetence. In: Umeora OUJ, Egbuji CC, Onyebuchi AK, Ezeonu PO, eds. Our Teachers – A comprehensive textbook of Obstetrics and Gynaecology. 1st ed. Abakaliki, Nigeria: ST Benedict Printing and publishing; 2017:397-400.
- Nkyekyer K. Cervical incompetence. In: Kwawukume EY, Ekele BA, Danso KA, Emuveyan EE, eds. Comprehensive Obstetrics in the tropics. 2nd ed. Accra-North, Ghana: Assemblies of God Literature Centre Ltd; 2015:415-420.
- Adeniran AS, Aboyeji AP, Okpara EU, Fawole AA, Adesina K.T. Pregnancy outcome in cervical incompetence: comparison of outcome before and after intervention. Trop J Obstet Gynaecol. 2014;31(1):23-28.
- Stirrat G. Recurrent miscarriage. In: James OK, Steer PJ, Weiner CP, Gonik B, eds. In: High risk pregnancy, Management options. London, UK: WB Saunders Co Ltd; 1995.
- Adewole N, Isah AD, Okochi O. A five-year survey of cervical cerclage in a Nigerian Tertiary Hospital. J Gynecol Reprod Med. 2018;2(1):1-5
- Parilla BV, Haney EI, MacGregor SN. The prevalence and timing of cervical cerclage placement in multiple gestations. Int J Gynaecol Obstet. 2003;(80):123–127.
- Rechberger T, Uldbjerg N, Oxlund H. Connective tissue changes during normal pregnancy and pregnancy complicated by cervical incompetence. Obstet Gyaecol. 1988;71:563-567.
- Anthony GS, Calder AA, Macnughton MC. Cervical resistance in patients with previous mid-trimester abortions. Br J Obstet Gynaecol. 1982;89:1046-1049.
- MacDonald IA. Suture of cervix for inevitable miscarriage. J Obstet Gynaecol Br emp. 1957;64:346-350.
- Shirodkar VN. A new method of operation treatment for habitual abortion in second trimester of pregnancy. Antiseptic. 1995;52:299-300.
- Royal college of obstetricians and Gynaecologists. Cervical cerclage (Green-top Guidelines N0. 60). Available from: https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg60/. Accessed August 18, 2019.
- Bennett P. Preterm labour. In: Edmonds DK, Less C, Bourne T, eds. Dewhurst’s Textbook of Obstetrics & Gynaecology. 9th ed. West- Sussex, UK: John Wiley & Sons Ltd;2018: 378-405.
- Rust O, Odibo A. American College of Obstetricians and Gynaecologists Practice bulletin No.142: Cerclage for management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372–379.
- Okusanya BO, Isabu PA. Outcome of pregnancy with history-indicated cervical cerclage insertion in a low resource setting. J Maternal Foetal Neonatal Med. 2015;28(3):284-287.
- Ikimalo J, Izuchukwu KE, Inimgba N. Pregnancy outcome after cerclage for cervical incompetence at the University of Port Harcourt Teaching Hospital. Afr J Reprod Health. 2012;16(3):180-184.
- Saumu WM, Karau PB, Mitter MS. Outcome and complications of women undergoing cervical cerclage in a tertiary hospital in Kenya. Web Med Central Obstet Gynecol. 2010;1(9):WMC007932010. Available from: https://profiles.uonbi.ac.ke/jogengo/files/outcome_and_complications_in_women_undergoing.pdf. Accessed December 2, 2019.
- Awarts JM, Brons JT, Bruinse HW. Emergency cerclage: a review. Obstet Gynaecol Surv.1995;50(6):459-469.
- Secher NJ, Mc Cormack CD, Weber T. Cervical occlusion in women with cervical incompetence: Proposal for a randomized controlled trial with cerclage; with or without cervical occlusion. BJOG. 2007;114:649-e6
- Feyi-waboso PA, Umerurike CC. Management of cervical incompetence in Aba, South Eastern Nigeria. Nig J Med. 2005;14:400-440
- Waloch M. Cervical cerclage in the treatment of cervical incompetence in Zambian women. Clin Exp Obstet Gynecol. 1996;23:255-262.
- Osemwenkha AP, Osaikhuwuomwan JA. Cervical cerclage in a Nigerian tertiary hospital: A review. Niger J Surg Sci. 2014;24:1-6.
- Simcox R, Shennan A. Cervical cerclage in the prevention of preterm birth. Best Pract Res Clin Obstet Gynaecol. 2007;21:831-842.
- Grant A. Cervical cerclage to prolong pregnancy. In: Chalmer SL, Enkim M, Kierse M.J, eds. Effective Care in Pregnancy and Child Birth. Oxford, UK: Oxford University Press; 1992:633-646.
- Gomes CC, Almeida DC, Goncalves E, Silva AP. History indicated transvaginal cerclage; results from a single centre. Int J Reprod Contracept Obstet Gynecol. 2019;8(10):4062-4065.
- Cockwell HA, Smith GN. Cervical incompetence and the role of emergency cerclage. J Obstet Gynaecol Can. 2005;27(2):123-129.
- Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM. Cerclage for short cervix on ultrasonography: Metaanalysis of trials using individual patient level data. Obstet Gynecol. 2005; 106(1):181-189.
- Chanrachakul B., Herabutya Y. The epidemiology of cervical incompetence in Ramalhibodi Hospital between 1982-1997. J Med Asso Thai. 1999;82(8):749-753.
- Drakeley AJ, Roberts D, Alfirevic Z. Cervical stitch (cerclage) for preventing pregnancy loss in women. Cochrane Database Syst Rev. 2003;1:CD003253
- Rush RW, Isaacs S, McPherson K, Jones L, Chalmers I, Grant A. A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery. Br J Obstet Gynaecol. 1984;91(8):724-30.