NEW MODIFIED SHIRODKAR TECHNIQUE “AKHAN TECHNIQUE” FOR URGENT CERCLAGE; ANALYSIS OF PRELIMINARY DATA
Objective
Objectives of this study is to present and discuss preliminary data on the efficacy of the modified Shirodkar cerclage technique applied to patients identified as “Urgent Cerclage” in a highly homogeneous patient group.
Materials and Methods
Fifty-four patients with singleton pregnancy and no additional perinatal pathology were included in the study, which was set to be performed from January 2017 to December 2021. The authors have no disclosure.
Details of the Cerclage Technique are shown in figure 1.
The clinical data of the patients who gave birth before and after 34 weeks of gestation were compared. ANOVA was used for quantitative data, and chi-suared test was used for qualitative data. Statistical analysis was performed using MedCalc® Version 19.8.
Results
The mean preoperative cervical length was 16.31±6.42 mm, and the mean cervical length after cerclage was 31.06±4.94 mm (p<0.0001). Mean delivery week was 35.02±3.2. The operation time was found to be 29.56 ± 7.55 minutes (max: 47; min: 18).
Distance between suture and external os vs time between surgery and delivery week there was a positive correlation (r= 0.303; p: 0.025)
| N=13< 34 w. | 34 w < N=41 | p< 0.05 | |
| Age | 33,3±7,25 | 33,56±4,75 | 0.884 |
| Cerclage week | 19,38±3,25 | 19,36±2,93 | 0.984 |
| Prior cerclage | 3 (33%) | 11 (27%) | 0.789 |
| PRTM or II.TM abortus | 10 (77%) | 22 (54%) | 0.14 |
| Funneling | 8 (62%) | 22 (54%) | 0.621 |
| Preop. C.L.(mm) | 11,61±3,66 | 17,7±6,41 | 0.002* |
| Post. C.L. (mm) | 28±5,64 | 32,04±4,33 | 0.009* |
| 15mm> cervical length | 10 (77%) | 12 (29%) | 0.0025* |
| Suture-Ex. os distance(mm) | 20,3±4,3 | 23,75±3,47 | 0.005* |
| Time Suture – Deliv. (week) | 15,46±4,85 | 17,7±3,33 | 0.065 |
Table 1: Data of patients who gave birth before and after 34 weeks of gestation
Preop C.L.: Preoperative cervical length; Post. C.L.: Postoperative cervical length; Sut-Ex os Distance : Suture - external os distance; Time Suture – Deliv.: Time between suture delivery
Conclusion
We propose that our modified technique is a good option for patients who are in the Urgent cerclage group or who have a previous history of unsuccessful vaginal cerclage. Although preliminary data support this view, more data is needed for objective evaluation.
