A Systematic Review of Elective, Urgent and Emergency Cervical Cerclage and Pregnancy Outcomes.

ABSTRACT

Introduction: Different cervical cerclage namely elective, urgent and emergency are in practice and they aim to improve the maternal and perinatal outcomes. Methods: The aim of this systematic review and analysis is to assess the difference in the outcomes of the three different cerclages. Randomized or quasi randomized controlled studies from last 15 years were considered in this study. The relative risk was calculated with 95% confidence interval and the maternal and perinatal outcomes were compared. Results: A total number of 923 patients were analyzed from the nine studies. Out of these 923 patients, 783 patients had adverse maternal outcome whereas all the patients had some form of adverse perinatal outcome. The urgent cerclage was comparable with the elective cerclage in most of the outcomes except having 3-4 folds higher pregnancy loss but 75% lower neonatal deaths. The emergency cerclage showed poor outcomes when compared to both urgent and elective cerclage with a very high risk of chorioamnionitis and less term births with high risk of neonatal deaths. Conclusion: Elective cerclage seems to have an overall better outcome when compared to the other two cerclages. The urgent cerclage is comparable to elective cerclage with lesser risk of neonatal death but a threefold higher risk of pregnancy loss. The emergency cerclage has shown poor outcome when compared to the other two types of encerclage. Therefore it can be recommended to evaluate the cervical length after one previous preterm delivery and if would to be less than 25 mm then a cervical cerclage should be considered.