[Efficacy of elective cerclage in patients with cervical incompetence and associated risk factors]

Cervical incompetence (CI) is considered as a defect of the cervical estroma that takes to the inability of the uterine neck to retain an intra-uterine pregnancy until the viability of the fetus, with an incidence from 0.05% to 1% of all the pregnancies. This defect in the cervix is due to obstetrics trauma, such as disfunctional and anatomical causes. The failure of cervical cerclage have been reported up to 20%, this study was carried out to determine the baby born and procedure complications. All patients demanding attention at the Gynecology and Obstetrics Hospital of the Medical Center La Raza, with diagnosis of CI were included in this study. Thus, 36 patients were included, with 30.1 +/- 4.2 (M +/- SD) year-old age; the cerclage was performed in the second trimester, in order to extend the pregnancy with an average of 18.1 +/- 6.5 weeks until the moment of the interruption of the pregnancy. The 61.1% arrived to the term gestation, in 23 of the cases (63.8%) were born with more than 2500 g of weight, and 24 cases also presented a recurrence among 2 to 5 abortions. The most frequent complication was the threat of preterm childbirth and in patient with antecedents of previous obstetric complications was obtained a relative risk (RR) of 3.8 to present CI, moreover it was also observed at the beginning and the end of the obstetric life the probability of CI has a RR 1.6, with a positive correlation between the gestational age at the application of the cerclage and the continuation of the pregnancy (p < 0.05) after the week 16 of gestation. The cerclage application in the second trimester of pregnancy overcomes the risks of the surgical procedure and does not have adverse effects on the product. The main indicators of success are the cerclage application to smaller gestational age, into the second and third gestation, as well as the presence of the smallest number of complicated obstetric events, therefore great part of the obstetric decision to apply a cerclage should be based on previous obstetric life of each patient.