Outcome and Complications in Women undergoing cervical cerclage in a tertiary hospital in Kenya

Abstract

Objective: To determine the immediate and late complications of women undergoing cervical cerclage, as well as their pregnancy outcomes. Methods: This was a retrospective study based on traceable patient records over a 9-year period (2000 to 2008) undertaken at the Kenyatta National Hospital, Kenya’s major referral and teaching hospital. All files on women diagnosed with cervical incompetence and treated by MacDonald’s stitch insertion were scrutinized. Details on patients’ age, gestation age at cerclage, immediate and late presentation and pregnancy outcome were collected. Comparisons were done for complications and pregnancy outcomes among emergency, elective and empirical cerclage groups. Results: Complete medical records of 199 patients who underwent cerclage over this period were retrieved. They ranged from 17 to 42 years of age, with an average of 27.97 years. Majority of the patients presented at gestation of 10 to 20 weeks (90.1%). Major complications recorded include vaginal haemorrhage and urinary tract infections. For the 174 women whose complete pregnancy records were traceable, 53.3% delivered at full term, 19.6% had pre-term delivery, 7.5% had intrauterine fetal death and 7.0% had abortions. Conclusions: This study adds to the existing knowledge on the controversial diagnosis of cervical incompetence and the use of cerclage in the African population. There is a relatively high incidence of complications among cerclage patients. The incidence of intrauterine fetal deaths among cerclage patients is underreported. More comprehensive randomized studies are needed to compare pregnancy outcomes in cerclage and control groups.