EVALUATION OF PERINATAL OUTCOMES IN PREGNANT WOMEN WHO UNDERWENT PROPHYLACTIC AND EMERGENCY CERCLAGE

Öz

Objective: The aim of this study was to compare prophylactic and emergency (rescue) cerclage procedures in pregnant women diagnosed with cervical insufficiency and to evaluate the effects of these two approaches on pregnancy duration and perinatal outcomes. Material and Methods: Between January 2021 and December 2024, 76 pregnant women diagnosed with cervical insufficiency who underwent McDonald cerclage at a tertiary center were retrospectively reviewed. Patients were divided into two groups: those who underwent prophylactic cerclage based on their medical history and those who underwent emergency cerclage based on physical examination or ultrasonographic findings. Demographic characteristics (age, gravida, parity, history of abortion, body mass index), gestational week at cerclage, indication, interval from cerclage to delivery, gestational week at delivery, birth weight, 1st- and 5th-minute Apgar scores, mode of delivery, and neonatal intensive care unit (NICU) requirement were recorded and compared between the groups. Results: The mean gestational week at cerclage was 14.3±2.3 in the prophylactic group and 21.3±1.8 in the emergency group. The interval from cerclage to delivery and the gestational week at delivery were longer in the prophylactic group (21.89±4.80 weeks / 36.25±3.12 weeks; p<0.001 and p=0.003, respectively). Birth weight was higher (2833.7±674 g vs. 2400.3±789.7 g; p=0.014) and NICU requirement was lower (p<0.001) in the prophylactic group. Conclusion: Emergency cerclage may prolong pregnancy duration when compared to cases without cerclage. However, prophylactic cerclage is associated with more advanced gestational age at delivery, higher birth weight, and a lower need for neonatal intensive care.

Anahtar Kelimeler

• Cervical cerclage
• emergency cerclage
• prophylactic cerclage
• perinatal outcomes
• preterm birth
• cervical insufficiency.

Profilaktik ve Acil Serklaj Uygulanan Gebe Kadınlarda Perinatal Sonuçların Değerlendirilmesi

Öz

Amaç: Bu çalışmanın amacı, servikal yetmezlik tanılı gebelerde uygulanan profilaktik ve acil serklaj yöntemlerini karşılaştırarak, bu iki yaklaşımın gebelik süresi ve perinatal sonuçlar üzerindeki etkilerini değerlendirmektir. Gereç ve Yöntemler: Ocak 2021-Aralık 2024 tarihleri arasında, tersiyer merkezde servikal yetmezlik tanısı ile McDonald tekniği kullanılarak serklaj uygulanan 76 gebe retrospektif olarak incelendi. Hastalar, öyküye dayalı profilaktik serklaj uygulananlar ve fizik muayene veya ultrasonografi bulgularına göre acil serklaj uygulananlar olarak iki gruba ayrıldı. Demografik özellikler (yaş, gravida, parite, abortus öyküsü, beden kitle indeksi), serklaj haftası, endikasyon, serklaj ile doğum arasındaki süre, doğumdaki gebelik haftası, doğum ağırlığı, 1. ve 5. dakika Apgar skorları, doğum şekli ve yenidoğan yoğun bakım gereksinimi kaydedildi ve gruplar arasında karşılaştırıldı. Bulgular: Profilaktik serklaj grubunda serklaj haftası 14,3±2,3; acil serklaj grubunda 21,3±1,8 idi. Serklaj ile doğum arasındaki süre ve doğumdaki gebelik haftası, profilaktik grupta daha uzundu (21,89±4,80 hafta / 36,25±3,12 hafta; p<0,001 ve p=0,003). Doğum ağırlığı profilaktik grupta daha yüksek (2833,7±674 g vs. 2400,3±789,7 g; p=0,014), yenidoğan yoğun bakım ihtiyacı ise daha düşüktü (p<0,001). Sonuç: Acil serklaj, gebelik süresini uzatmakta ve perinatal sonuçları iyileştirmektedir. Ancak profilaktik serklaj, daha ileri gebelik haftası, daha yüksek doğum ağırlığı ve daha az yenidoğan yoğun bakım ihtiyacı ile ilişkilidir.

Anahtar Kelimeler

• Servikal serklaj
• acil serklaj
• profilaktik serklaj
• perinatal sonuçlar
• preterm doğum
• servikal yetmezlik.

Kaynakça

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