Cervical incompetence: surgical treatment of twenty-four cases during pregnancy.

ONE of the most exciting concepts in obstetrics and gynaecology is that of the mechanical function of the cervix in the maintenance of pregnancy. In 1947 Danforth provided the first satisfactory anatomic explanation of the role of the cervix in retaining pregnancy, and pointed out the correlation of this important function with the prevention of abortion. The first clinical report of the repair of an incompetent cervix with a satisfactory result in two subsequent pregnancies was that of Palmer & La Comme in 1948. In 1950, Lash & Lash described the diagnosis and repair of cervical defects as they are related to recurrent late abortions. Since then 'cervical incompetence' has become a well-known entity and many cases of successful surgical repair of the defect have been reported. Some of these operations were performed by trachelorrhaphy either prior to (Palmer & La Comme, 1948; Rubovits, Cooperman & Lash, 1953; Picot, Thompson & Murphy, 1958) or during pregnancy (Baden & Baden, 1957). Following Shirodkar's paper in 1955, the emphasis has been upon repair of the cervical defect during pregnancy by means of a constricting suture (Barter et al., 1958; Johnstone, 1958; McDonald, 1957; Tacchi & Snaith, 1962). The syndrome described as the 'incompetent cervix' refers to a defect of the cervix usually, but not always, resulting from a previous labour or surgery, which leads to the premature termination of an otherwise normal pregnancy during the middle trimester. The author presents a series of twenty-four cases treated in a busy obstetrical-gynaecological unit over a period of 5 years where the preferred policy is to correct the cervical defect during pregnancy, using a modified Shirodkar technique similar to that described by Tacchi & Snaith (1962). The method of termination of pregnancy of the successfully treated cases was vaginal delivery, except in the presence of an obstetrical indication for Caesarean section other than cervical incompetence.