Diagnostic criteria and pregnancy outcomes in patients with cervical insufficiency at Kenyatta National Hospital from 2010 to 2013.

Abstract

INTRODUCTION: Prematurity is the leading cause of perinatal mortality and morbidity in Kenya and globally. Cervical insufficiency has been known as among the causes of premature delivery and especially recurrent preterm pregnancy loses. Cervical cerclage has been reported to offer some benefit in management of cervical incompetence. OBJECTIVE: To determine the diagnostic criteria and pregnancy outcomes in patients with cervical insufficiency at Kenyatta National Hospital between 1st January 2010 to 31st December 2013. STUDY DESIGN: This is a hospital based Descriptive Cross-sectional study. STUDY SETTING AND SITE: The study was conducted at the Department of Reproductive Health, KNH. STUDY POPULATION: The study population was files of all women with a diagnosis of cervical insufficiency who underwent cerclage at KNH from 1st January 2010 to 31st December 2013. SAMPLE SIZE: A total of 316 women had a diagnosis of cervical insufficiency and cerclage at KNH during the study period. Sample size was calculated to be 163. A total 168 files were reviewed. DATA COLLECTION: Data was collected using a structured abstraction form prepared by the principal investigator. The abstraction form was administered by the principal investigator and a trained research assistant. DATA ANALYSIS: Data was presented in tables, graphs and charts. Analysis was carried out using SPSS version 18.0. Statistical significance was based on alpha level of 0.05. RESULTS: Prevalence of cervical insufficiency was 1.26% in the antenatal population.Only 3.2% had a trans vaginal ultra sound scan for cervical length evaluation. There were complications after cerclage with PROM and preterm labour being the commonest. Only 56.6% of the study population carried pregnancy to term after cerclage. CONCLUSION: Ultra sonography as a tool for evaluation of women with cervical insufficiency was not fully and correctly utilised. Premature delivery remained a significant occurrence in women with cervical insufficiency after cerclage. RECOMMENDATION: Development of a Standard Operating Proceedure for diagnosis and management of cervical insufficiency at KNH.