%0 Journal Article
%T Use of Cervical Cerclage as a Treatment Option for Cervical Incompetence: Patient Characteristics, Presentation and Management over a 9 Year Period in a Kenyan Centre
%A PB Karau
%A MG Mutwiri
%A JA Ogeng¡¯o
%A GM Karau
%J African Journal of Reproductive Health
%D 2013
%I Women's Health and Action Research Centre (WHARC)
%X Treatment of cervical incompetence by cerclage and other methods has yet to be standardized, as its diagnosis is not uniformly accepted. Its diagnosis, particularly in the African setting, is mostly based on past obstetric history of pregnancy losses, while in developed centres; ultrasound diagnosis is increasingly being used. The mainstay of treatment in developing countries is cervical cerclage, although the indications and contraindications of this mode of treatment are not documented. Our aim was to appraise this practice in terms of patient characteristics, the diagnostic process and management at the Kenyatta National Hospital, Nairobi, Kenya. This was a descriptive retrospective study over 9 years. Predesigned questionnaires were employed to collect data on patient¡¯s socio-demographic profile, presentation, risk factors, diagnosis and management of cervical incompetence. Chisquared test and student¡¯s t-test were used to correlate variables. A total of 199 patients were treated for cervical incompetence, with the patient mean age being 27.97. 87.4% of the patients (p=0.02) were in the 20 to 35 years category. Most of the patients (60.1%) were of low socio-economic status. Cervical cerclage was employed in all the patients, although ultrasound investigation was not employed in 65.8% of them. Diagnosis of cervical incompetence still relies on history of previous pregnancy losses, with the standard transvaginal ultrasound relatively unemployed. There is need to intensify investigations for this condition, standardize the indications for cerclage, and diversify management to other newer modalities. R¨¦sum¨¦ Le traitement de l¡¯insuffisance cervicale par le cerclage n'a pas encore ¨¦t¨¦ standardis¨¦, ¨¦tant donn¨¦ que son diagnostic n'est pas uniform¨¦ment accept¨¦. Son diagnostic en Afrique, est principalement bas¨¦ sur les ant¨¦c¨¦dents obst¨¦tricaux de pertes de grossesse, alors que dans les centres d¨¦velopp¨¦s, le diagnostic ¨¦chographique est utilis¨¦. Notre objectif ¨¦tait d'¨¦valuer cette pratique en termes de caract¨¦ristiques des patientes, le processus de diagnostic et de gestion ¨¤ l'H pital National Kenyatta, ¨¤ Nairobi, au Kenya. Il s'agissait d'une ¨¦tude r¨¦trospective descriptive qui a dur¨¦ 9 ans. Les questionnaires pr¨¦con us ont ¨¦t¨¦ utilis¨¦s pour recueillir des donn¨¦es sur la situation sociod¨¦mographique des patientes, la pr¨¦sentation, les facteurs de risque, le diagnostic et la gestion d'insuffisance cervicale. Le Test du chi carr¨¦ et le test de t de l¡¯¨¦tudiant ont ¨¦t¨¦ utilis¨¦s pour corr¨¦ler les variables. Un total de 199 patientes ont ¨¦t¨¦ trait¨¦es pour l¡¯insuffisance cervicale, l'age moyen des patientes ¨¦tant de 27,97. 87,4% des patientes (p = 0,02) se trouvaient dans la cat¨¦gorie des 20 ¨¤ 35 ans. La plupart des patientes (60,1%) ¨¦taient de faible statut socio¨¦conomique. Le cerclage du col ut¨¦rin a ¨¦t¨¦ utilis¨¦ chez toutes les patientes, bien qu¡¯on n¡¯ait pas men¨¦ une enqu¨ºte ¨¦chographique aupr¨¨s des 65,8% d'entre elles. Le diagnostic d'insuffisance ce
%U http://www.ajol.info/index.php/ajrh/article/view/86439