Emergency Cervical Cerclage

Wierzchowska-Opoka, Magdalena; Kimber-Trojnar, Żaneta; Leszczyńska‐Gorzelak, Bożena

doi:10.3390/jcm10061270

Cited by 25 publications

(30 citation statements)

References 81 publications

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“…After analyzing all the above data and in accordance with the updated literature [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ], we conclude that the use of our TSEC technique could extend the latency period and, accordingly, result in lower prematurity rates. Its effect was especially beneficial in patients with poor prognoses (prolapsed membranes, cervical dilatation, conization patients), for whom outcomes in most studies have been unsatisfactory.…”

Section: Discussionsupporting

confidence: 72%

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Gómez-Castellano

Sabonet

González-Mesa

et al. 2022

IJERPH

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(1) Background: The objective of our prospective observational study was to evaluate a new technique for emergency cerclage, which was performed on a cohort of patients with cervical incompetence in the second trimester. (2) Methods: 26 pregnant women presented at 15 to 24 weeks of gestation with cervical dilatation and bursa prolapse. A new emergency cerclage was performed using a technique consisting of the first cerclage in a tobacco bag and a second occlusive cerclage located inferiorly to the first. The technique is concluded with the performance of a cervical cleisis when vaginal bag prolapse is present, and this overall procedure is called the three-step procedure for emergency cerclage (TSEC). (3) Results: To assess its effectiveness, we measured the latency from procedure to delivery, pregnancy duration, infant birth weight, and rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of newborns was 2550 g and the mean gestational age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis (<34 weeks gestational age) was 8.3% (two cases) with successful perinatal outcomes. There were significant differences (p < 0.05) between groups. A multivariate regression model showed that the best variables for predicting the latency to delivery were the cervical dilatation at diagnosis, use of the three-step cerclage, cervical length after the procedure, and gestational age at diagnosis. (4) Conclusions: The excellent results obtained with the TSEC procedure in terms of the latency from the procedure to delivery, gestational age at delivery, birth weight, and having few reported complications highlight the importance of collecting new data on this promising novel procedure.

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Section: Discussionsupporting

confidence: 72%

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Gómez-Castellano

Sabonet

González-Mesa

et al. 2022

IJERPH

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“…Clear bene t has been demonstrated in the use of a cerclage in a woman with a cervical length < 25mm with 2 or more mid-trimester losses, and could be considered in a twin pregnancy with a cervical length < 15 mm (2, 3). There is also a role for an emergency cerclage placement in a dilated cervix <3cm (4,5).…”

Section: Introductionmentioning

confidence: 99%

Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion

Adedipe

Akintunde

Chukwujama

2022

Arch Gynecol Obstet

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Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is signi cant di culty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2 nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with subsequent neonatal morbidity and mortality.A retrospective review of cases managed by additional surgical techniques and protocols increased the likelihood of a successful insertion in this cohort of patients. This was supported by adjuvant postoperative management protocol which included vaginal progesterone use, regular infection screening and lifestyle advice.Cerclage insertion was mostly from 18-20 weeks gestational age (GA) with an increased gestational latency of 13 gestational weeks (range 12-18) with all deliveries after 34 weeks GA. Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241-264 days in this small cohort of patients with minimal surgical complications and corresponding good neonatal outcomes.This technique has the potential to be a bene cial therapeutic option in management of an incompetent mid-2nd trimester absent ecto-cervix.

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“…For women with a history of cervical insufficiency, preventive cervical cerclage is an effective surgical method for treating cervical insufficiency, which can effectively prolong the gestational age and reduce the adverse perinatal outcomes [3,[7][8][9][10]. However, for women with the first pregnancy, or those without a history of midtrimester pregnancy loss or spontaneous preterm birth, emergency cervical cerclage (ECC) is a salvage procedure when cervical dilation with bulging fetal membranes but no signs of labor and infection in mid-trimester, in an attempt to prolong the pregnancy to a viable gestation [11][12][13][14]. However, compared to the elective cervical cerclage, ECC is a technically challenging procedure, as the protruding membranes in the cervix making it difficult to place the cervical suture properly and carry the risk of iatrogenic rupture of the membranes during surgery [11][12][13]15].…”

Section: Introductionmentioning

confidence: 99%

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study

et al. 2022

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The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group (n = 16) and non-amnioreduction group (n = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, P < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, P = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; P > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% (P > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.

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Emergency Cervical Cerclage

Cited by 25 publications

References 81 publications

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study

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