MATERNAL AND INFANT FOLLOW-UP AFTER TOTAL CERVICAL OCCLUSION

From August 16, 1993 until March 6, 1995 a study was conducted at the Department of Obstetrics at the Berlin-Neukoelln Womens Hospital to ev aluate the status of patients who had previously undergone total cervi cal occlusion (TCO) for the prevention of late abortion and premature birth. Special consideration was given to the possible effects of TCO on the patients' gynecologic status, the psychological circumstances a ssociated with TCO and the developmental status of the infants. Fifty- four women participated in the study, their ages ranging between 26 an d 53 years, The mean time-span between the TCO procedure and the prese nt study was five years and five months. In the 54 women undergoing TC O, a total of 73 such procedures were performed. An extensive early TC O was performed in 63% and an extensive late TCO in 20.5%. The gestati onal age at the time of delivery was greater than or equal to 37 + 0 w eeks in 67.1% of the women. More than half of the patients (54.9%) exp erienced a normal spontaneous vaginal delivery. In total, 84.5% of the infants were delivered vaginally; thus the cesarean section rate was only 15.5%. Regarding the patients' medical histories, the majority of the patients had do pathological findings on routine pap smears and p elvic examinations and, similarly, they had no complaints of menstrual irregularities. Only 10 patients (18.5%) underwent gynecological surg ery in the interim; in these patients, the most common reason for surg ery (in four cases) was sterilisation. The findings during speculum ex amination were tabulated. The majority of the patients (96%) exibited a normal multiparous cervical portio. In 55% of the patients there was no evidence of scarring of the cervical portio. In 25% of the patient s there was minor cervical scarring, ih 13.5% it was moderate and in 5 .8% it was severe. Except for a single case, the patients showed no ev idence of vaginitis. During bimanual palpation on pelvic examination, in 82.7% of the patients the cervix was found to be at least 2 cm in l ength, a closed external cervical os was palpated in 65.4%, and an ant eflexed/anteverted uterus that was normal in size and form was noted i n 46.2%. In 95.4% of the patients, original squamous epithelium was se en colposcopically. The psychosocial status of each patient was evalua ted on an individual basis. After taking all of the psychosocial circu mstances associated with such a high-risk pregnancy into consideration , all the patients giving birth to a living infant described that even t as a positive experience. However, this was not the case in the two patients whose premature infants did not survive. In 74.1% of the pati ents, the relationship with their domestic partners was described as ' 'unchanged'' when compared to the status of their relationship during the preceding pregnancy without TCO. The patients undergoing TCO descr ibed their own psychological status as ''frequently strained'' (61.1%) and ''disturbed'' (9.3%) antepartum. Postpartum, 90.7% of the patient s described their psychological status as ''good'' In total, there wer e 74 births in the 54 patients included in this follow-up study. Of th ese 51 (68.9%) were living term infants, one stillborn (1.4%) and 22 ( 29.7%) premature infants. One infant weighed less than 1.000 grams whi le 4 (5.3%) weighed between 1.000 and 1.499 grams. Postpartum, 45.5% o f the premature infants and 19.6% of the term infants were hospitalize d. The primary indications for the transfer of the premature neonates were intensive care, hyperbilirubinemia and adaptation problems. The p hysical, emotional and mental development was unimpaired in 91.4% of t he children. A capability for good social integration was displayed in 95.7% of the children. Based on the current investigation, it may be concluded that the total cervical occlusion procedure has no significa nt long-term negative effects.