Emergency Cerclage

Abstract

The treatment of patients with cervical incompetence presenting with advanced cervical changes in the second trimester remains a challenge to every obstetrician. Cerclage operation may be the only hope for prolonging gestation until fetal viability is reached. A retrospective study on so-called emergency cervical cerclage in 20 patients with supposed cervical incompetence in the late second trimester is presented, together with a review of comparable studies published between 1980 and 1992. It is concluded that emergency cerclage can be of benefit, and that the pregnancy is saved in the majority of cases, although the incidence of complications, often due to infection, is high. Many patients require prolonged hospitalization or bed rest and few pregnancies reach full term. There is a particularly high rate of infectious complications and attention must be focused on preventing chorioamnionitis to improve the outcome of the procedure in the future.

Emergency Cerclage: Improvement of Outcomes by Standardization of Management

“…However, it seems reasonable to use a short course of broad-spectrum prophylactic antibiotics as in any other surgical procedure involving the vagina. On the other hand, tocolysis is not used systematically as some authors [7,9,16,17] do not use tocolysis at all while others use indomethacin [5,14,18] or ritodrine [19,20,21]. Finally, amniocentesis prior to the indication of cerclage has been suggested by Mays et al [22] who showed that selection of women according to the results of the amniocentesis improved perinatal results.…”

“…Data regarding the technique are heterogeneous, with some authors using only the McDonald technique [9,10,18,21,23] and others using the McDondald or the Shirodkar technique depending on operator experience [6,8,20,22]. In the review by Aarts et al [16], the authors found no evidence that the technique used influences the prolongation or the outcome of pregnancy. Therefore, in our protocol, the cervical technique was left to the discretion of the operator.…”

Die Zervix in der Gravidität als dynamisches Organ: 4 Kasuistiken von Patientinnen mit Muttermundbefund und vorgewölbter Fruchtblase, welcher sich zu einem Zervixbefund zurückbildete - The Cervix in Pregnancy as a Dynamic Organ. 4 Case Reports on Patients with Findings at the Opening of the Uterus and Inflated Amniotic Sac that Returned to a Stationary Condition of the Cervix -

“…In unseren Fällen wurden alle Patientinnen mit intravenöser Tokololyse, Lungenreifung, Bettruhe und Antibiotika therapiert. In der Literatur finden sich Berichte, welche die [15,16].…”

Cervical cerclage

“…35 The prognosis is in¯uenced by the gestational age at the time of suture placement. 36 Orr 37 reported the technique of using a Foley catheter balloon with the tip cut off as a counterpressure to the bulging bag of membranes. This is pushed into the lower uterus and a McDonald stitch placed round the cervix.…”