Favorable outcome following emergency second trimester cerclage

• Published in: International journal of gynecology and obstetrics Vol. 96; no. 1; pp. 16 - 19
• Main Authors: Debby, A., Sadan, O., Glezerman, M., Golan, A.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-01-2007; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cerclage, Cervical - adverse effects; Cohort Studies; Emergency cerclage; Emergency Treatment - adverse effects; Female; Gynecology. Andrology. Obstetrics; Humans; Infant, Newborn; Intensive Care, Neonatal; Medical sciences; Neonatal outcome; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, Second; Retrospective Studies; Uterine Cervical Incompetence - surgery; Pregnancy; Neonatal outcome; Emergency cerclage; Human; Second trimester; Surgical cerclage; Neonatal; Prognosis; Gynecology; Obstetrics; Newborn; Female; Emergency
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2006.09.002

Abstract Background To evaluate the outcome of midtrimester emergency cerclage with or without bulging of membranes. Methods A retrospective cohort study of 99 women who underwent emergency second trimester cerclage (16–27 gestational weeks). In 75 women the cervix was dilated and effaced but without bulging of membranes (group 1), and in 24 women the dilation and effacement of the cervix were accompanied by bulging of membranes into the vagina in an hourglass formation (group 2). McDonald technique was applied in all patients. Results Prolongation of pregnancy was significantly longer in group 1 compared to group 2 (14.3 ± 6.5 vs 9.3 ± 4.8 weeks, p = 0.007). The mean gestational age at delivery was significantly higher in group 1 compared to group 2 (34.6 ± 4.6 vs 29.5 ± 3.2 weeks, p = 0.001). The incidence of chorioamnionitis was higher in group 2 compared to group 1 but statistically insignificant (25% vs 15%, p = 0.2). The overall neonatal survival was 83% (82 out of 99 neonates), without statistical difference between the two groups (86% in group 1 and 71% in group 2, p = 0.2). Conclusions Favorable neonatal outcome may be accomplished in patients with cervical incompetence in the second trimester of pregnancy following cervical emergency suturing even performed when the membranes are bulging through the cervix into the vagina.