Effectiveness of double cervical cerclage in women with at least one previous pregnancy loss in the second trimester

Recurrent pregnancy loss in second trimester is defined as three or more losses although most authors consider clinical treatment with 2 consecutive miscarriages at 14-18 weeks of gestation.Impaired early trophoblastic invasion, premature intervillous-space blood flow, fragmentation of the trophoblastic shell, subsequent oxidative damage, and intervillous or placental thrombosis are important mechanisms in placental pathology in recurrent miscarriage.Genetic, anatomical, immunological endocrine factors, blood coagulation protein or platelet defects, infectious causes and environmental factors are the causes of recurrent miscarriage in addition to unexplained miscarriage.Cervical incompetence is defined as recurrent second trimester loss of pregnancy caused by an insufficiency or uterine cervix to retain pregnancy until term. Women with a history of cervical incompetence and preterm birth have an increased risk of a similar event in subsequent pregnancies. Cervical cerclage such as McDonald suture or Shirodkar suture was usually performed in those women, so that a recurrent preterm delivery could be prevented. It may significantly improve perinatal outcome in women with at least one previous pregnancy loss in the second trimester.The aim of the work was to evaluate the effect of double cervical cerclage on the prevention of preterm delivery and perinatal outcomes in women with previous fetal loss in the second trimester.This interventional prospective randomized controlled study was conducted in Obstetrics and Gynaecology Department in a period from 13 months from March 2011 to April 2012.It included patients who attend the Outpatient Clinic with suspected cervical incompetence either by previous obstetric history or by ultrasound examination with gestational age between 14 and 18 weeks. The patients were randomly allocated into 2 groups; group 1 included 20 patients who had traditional modified MacDonald operation using a 5 mm mersilene tape in the middle third of the cervix and group 2 included 20 matched patients who had double cervical cerclage with two purse-string sutures using two 5 mm mersilene tapes; one in the upper third and one in the lower third of the cervix. Dissection of the bladder from the uterus was performed if the cervical length is too short to perform double cerclage. All patients gave informed and signed consent before entering the study.The results of this study concluded that double cervical cerclage not improve perinatal and maternal outcome in women with cervical incompetence. However, this needs to be verified by a larger study.