| Abstract: |
Approximately 10% of pregnancies end in preterm delivery, defined as a delivery that occurs before 37 weeks of pregnancy. Premature birth is a major cause of serious health problems in neonates, including respiratory distress, difficulty regulating body temperature, and infection. More than 85% of long-term disabilities and 75% of deaths among newborns occur as a result of preterm delivery (Chao et al 2011).Cervical length during prenatal care, has been demonstrated to be the most sensitive prenatal predictor of preterm birth between both high- and low-risk women. In a mixed high- and low-risk population of singleton pregnancies, transvaginal ultrasound-measured cervical length was highly correlated with the risk of spontaneous preterm delivery before 35 weeks. (Sotiriadis et al., 2010).Transvaginal ultrasound is the most reproducible technique for cervical assessment. When a short cervix is suspected by transabdominal sonography, a transvaginal ultrasound examination should be performed to obtain the true cervical length. (Berghella et al., 2009), shortening of preoperative cervical length<2.5cm was considered by some obstetrician is an indication for cerclage (Drakley et al., 2003).cervical cerclage is a minor surgical procedure in which the opening to the uterus (the cervix) is stitched closed in order to prevent a miscarriage or premature birth. A cerclage is considered successful if labor and delivery is delayed to at least 37 weeks (full term) (Berghella et al 2011).This study is a prospective, clinical trial study that aimed to determine the effectiveness of cerclage for a transvaginal ultrasonographiclly diagnosed shortened cervix .The population of the study comprised 60 pregnant women with sonographically short cervix <2.5cm , at 11- 17 weeks gestation that divided into two groups the first whose underwent cerclage and the second whose did not. then subgroup analysis in cases with cerclage was done include ; Short cervix <2.5cm versus extremely short cervix <1.5 cm. and singleton pregnancy versus multiple pregnancy, then statistical Comparison between cases of short cervix alone as a risk factor in cerclage and non cerclge groups and Comparison between cases of singleton pregnancy with short cervix <2.5 cm and history of previous PTB in cerclage and non cerclge groups was done.The results of study revealed: Mean cervical length measurements were relatively longer after cerclage which proved to be statistically significant in the cerclage group and in the subgroup with short and extremely short cervix. cerclage procedure increases mean of gestational age at delivery and affects neonatal birth weight No benefit was found in the placement of a cerclage for a sonographically detected short cervix on the rates of preterm deliveries, neonatal mortality, neonatal morbidity and ICU admition. cerclage is beneficial to women that cervical length is less than 2.5cm.more than women that cervical length is less than 1.5cm. as in women with cervical length < 2.5cm. there is statistically significant difference in mean of gestational age at delivery , mean of birth weight and percentage of full term labor, neonatal morbidity and mortality. In the subgroup analysis of singleton gestations versus twin with short cervical length there were no statistically significant difference between both groups as regard maternal or neonatal outcome. Cerclage is not recommended in women without a history of spontaneous preterm delivery or second- trimester loss who have an incidentally identified ultrasonograohy short cervix of 25 mm or less. Cerclage is indicated in women with a history of one or more spontaneous mid-trimester losses or preterm births who undergoing transvaginal sonographic measurement of cervical length if the cervix is 25 mm or less ..
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