A new technique using a rubber balloon in emergency second trimester cerclage for fetal membrane prolapse

Abstract

Aim: Prolongation of pregnancy in cases of fetal membrane prolapse into the vagina during the second trimester is difficult using conservative therapy. After pushing the membranes back into the cervix, emergency cervical cerclage may be advantageous in improving the neonatal outcome.We have been managing membrane repositioning and emergency cervical cerclage with a technique using a rubber balloon device (known as a'mini metreu' in Japan), and we examined the efficacy of this technique in five cases. Methods: Our management was as follows: Initially, the full bladder technique was attempted under general anesthesia. If this was not effective, amnioreduction was performed by transabdominal amniocentesis. After the membrane repositioning using a mini metreu, double suture cervical cerclage (McDonald method + Shirodkar method) was performed. Results: The diameter of the bulging prolapsed membranes ranged from 30-84 mm, with a mean of 52 mm. Cerclage was successfully performed in all of the five cases. Prolongation of the pregnancy period was from 22-107 days (average; 77.6 _ 28.9 days). In cases 1-4, healthy newborns were delivered, but in case 5 sudden intrauterine fetal death due to umbilical cord complications occurred at 24 weeks of gestation. Conclusion: It appears that long-term prolongation of pregnancy is possible, when performing membrane repositioning using the mini metreu and emergency cervical cerclage for fetal membrane prolapse into the vagina.

Outcome of emergency cerclage for advanced cervical dilatation: a retrospective analysis

“…16 Kanai et al, 2008, presented 5 cases of bulging membranes that were all replaced in the uterine cavity using a balloon and mean prolongation of pregnancy was 77.6 days. 17 Such prolongation was well achieved in our series, with a mean pregnancy prolongation of 70.4 days. Cockwell et al, 2005, presented 12 cases of emergency cerclage in which the mean prolongation of pregnancy was 7 weeks and one day, with a neonatal survival of over 70%.…”

Balloon tamponade for successful emergency cervical cerclage

“…Kanai et al . have reported a similar balloon device to facilitate emergency cerclage, called the mini metreu.…”

“…Regarding to outcomes of neonates, our survival rate was 76.1%, favorably compared to a literature review including 683 cases, 16 which was 70.0% at average. Kanai et al 17 have reported a similar balloon device to facilitate emergency cerclage, called the mini metreu. However, they performed cervical cerclage twice using both McDonald and Shirodkar method during the procedure.…”

“…Nine women (23.1%) were multiparas, and nine women (23.1%) had a history of premature birth at the second trimester. The mean gestational age at the time of cerclage was 22.5 AE 2.5 weeks, and the median was 23 weeks (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The median degree of dilatation of the cervix was 2.0 (0.0-10.0) cm.…”

Low-Cost Rescue Cerclage Technique in Second-Trimester Cervical Dilation With Bulging of Membranes

“…Assaad Kesrouani, MD, Pr 1 , Sabine Esber, MD 1 , Bernard Nasr, MD 2 , Hicham Jabbour, MD, Pr 3 , Serges Sassine, MD 1 , and Elie Choueiry 4 Dear Editor, Cervical dilation associated with prolapsed fetal membranes is one of the leading causes of premature deliveries during the second trimester of pregnancy. Rescue cervical cerclage has been proven to prolong pregnancy by 4 to 5 weeks, reducing by 2-fold the risk of preterm birth before 34 weeks and seems superior to expectant management in the absence of chorioamnionitis, premature rupture of membranes and treatmentresistant uterine contractions.…”