Cervical dilation as a predictor of pregnancy outcome following emergency cerclage

Abstract

Women who receive a rescue cerclage are more likely to deliver at an earlier gestational age when cervical dilation is ≥ 2 cm at the time of procedure.

A single‐center retrospective study of pregnancy outcomes after emergency cerclage for cervical insufficiency

“…With respect to other outcomes such as frequency of term delivery, Apgar score at 5 minutes, and birth weight, the efficacy of emergency cerclage was equivalent to that of elective cerclage. The frequency of cesarean delivery was lower in the emergency group (27%) than in the elective group (48%), which suggests that emergency cerclage does not influence the mode of delivery, consistent with recent reports . Some retrospective studies have reported higher rates of procedure‐related complications, but no surgical complications occurred in the present study population.…”

“…Several studies have showed that membrane prolapse beyond the external os and/or a cervical dilation of 1.5 cm are independent predictors of cerclage failure. 8,10,13 In the present study, seven patients had cervical dilation at the time of the cerclage procedure, and most of these women had poor out- proposed cerclage for women with CL less than 15 mm, whereas a meta-analysis 15 has suggested that cerclage should be done for women with a previous history of preterm birth and CL less than 25 mm.…”

Emergency Cerclage: Improvement of Outcomes by Standardization of Management

“…Although most studies report the use of some kind of prophylactic antibiotics, some do not [4,9,14,15]. Results in the latter studies do not seem to differ from those including the systematic use of antibiotics.…”

“…In fact, in the review by Namouz et al [1], only 5 studies [4,9,15,18,29] reported a higher number of cases, and another 3 [7,23,30] reported 40 cases or more. In addition, in most studies a standard protocol of management was not followed, and in some reports (i.e.…”

“…Chorioamnionitis was described in 12.5-50% of cases in the review by Namouz et al [1], and Caruso et al [19] reported the need for a second emergency cerclage in 8% of women, which is in line with our study. Nevertheless, as potential maternal risk has been observed in emergency cerclage [15], a 12- to 24-hour interval between the diagnosis and the procedure was observed in order to exclude progression, uterine contractions or signs of clinical infection. This approach, together with the use of amniocentesis in the second period, may explain the absence of severe maternal morbidity in our study.…”