Exam-indicated cerclage in patients with fetal membranes at or beyond external os: A retrospective evaluation (original) (raw)
Related papers
Emergency cerclage in the presence of protruding membranes: is pregnancy outcome predictable?
Acta Obstetricia et Gynecologica Scandinavica, 2000
Background. The aim of this retrospective study is to verify whether some maternal features are related to pregnancy outcome in cases of emergency mid-trimester cerclage when membranes are protruding through the dilated cervix. Methods. Between 1988 and 1996 twenty-three pregnant patients with dilated cervix and protruding membranes were treated with emergency cerclage. At the time of cerclage, gestational age ranged from 17 to 27 weeks (median 22). Results. Pregnancy was prolonged from 0 to 20 weeks (median 4). Eleven living infants were born (46%); median gestational age at delivery was 25 weeks (range 21-39) and median birth weight 700 g (range 350-3980 g). Obstetric histories, white blood cell count, and vaginalcervical and urine cultures obtained on admission were analyzed in the two following groups: data from patients with good pregnancy outcome (live births) versus those from patients with poor outcome (stillbirths and neonatal deaths). No significant difference was found between the groups for the above mentioned maternal features.
American Journal of Obstetrics and Gynecology, 2000
A randomized trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimester preterm dilatation of the internal os OBJECTIVE: The aim of this study was to compare perinatal outcomes of patients with second-trimester ultrasonographic evidence of preterm dilatation of the internal os treated with cerclage versus those of patients not treated with cerclage. STUDY DESIGN: From May 1998 through June 1999 patients with ultrasonographic evidence of preterm dilatation of the internal os between 16 and 24 weeks' gestation were randomly assigned to receive a McDonald cerclage or no cerclage. Before random assignment all patients underwent amniocentesis and urogenital cultures and then received 48 hours of therapy with indomethacin and antibiotics. After treatment each patient was followed up as an outpatient with bed rest and weekly ultrasonographic evaluation. RESULTS: Of the 61 patients 31 were randomly assigned to cerclage and 30 were randomly assigned to no cerclage. There were no differences between groups with respect to maternal demographic characteristics, risk factors for preterm birth, cervical measurements, rescue procedures, readmission, chorioamnionitis, and abruptio placentae. The mean gestational age at delivery (33.5 ± 6.3 weeks) and the perinatal death rate (12.9%) in the cerclage group were similar to the mean gestational age at delivery (34.7 ± 4.7 weeks; P = .4) and the perinatal death rate (10.0%; P = .9) in the no-cerclage group. CONCLUSION: Treatment with McDonald cerclage of preterm dilatation of the cervix detected ultrasonographically during the second trimester did not improve perinatal outcomes. (Am J Obstet Gynecol 2000;183:830-5.)
American Journal of Obstetrics and Gynecology, 2014
the Obstetrix Perinatal Collaborative Research Network OBJECTIVE: The decision of whether to retain or remove a previously placed cervical cerclage in women who subsequently rupture fetal membranes in a premature gestation is controversial and all studies to date are retrospective. We performed a multicenter randomized controlled trial of removal vs retention of cerclage in these patients to determine whether leaving the cerclage in place prolonged gestation and/or increased the risk of maternal or fetal infection.
The Efficacy of Sonographically Indicated Cerclage in Multiple Gestations
Journal of Ultrasound in Medicine, 2005
The purpose of this study was to determine the efficacy of sonographically indicated cerclage in multiple gestations with sonographic evidence of short cervical length (CL). Methods. Between 1996 and 2002, all multiple gestations undergoing serial CL determinations in the second trimester were identified in 2 separate institutions. Cervical lengths were measured sonographically with transvaginal probes (4-8 MHz). Short CL was defined as a closed CL of 2.5 cm or less. When a short CL was identified before 24 weeks, the study group underwent sonographically indicated cerclage via the modified Shirodkar technique; control patients were placed on bed rest without surgical intervention. The primary outcome was incidence of spontaneous preterm birth before 32 weeks. The groups were compared with the Mann-Whitney U test and the Fisher exact test, with a 2-sided P < .05 used to define statistical significance. Odds ratios were calculated, and 95% confidence intervals were reported. Results. A total of 414 sets of twin gestations and 92 sets of triplet gestations were identified. The median gestational age at delivery for twin gestations was 34.0 weeks for patients who received cervical cerclage and 34.4 weeks for patients with short cervix and no cerclage (P = .77). The median gestational age at delivery for triplet gestations was 34.1 weeks for patients who received cervical cerclage and 33.0 weeks for patients with short cervix and no cerclage (P = .21). There was no difference in the rate of spontaneous preterm delivery at fewer than 28, 30, 32, and 34 weeks or in the rate of preterm premature ruptured membranes. Conclusions. In our study of multiple gestations with short CL, sonographically indicated cerclage was not associated with a lower incidence of spontaneous preterm delivery compared with conservative management.
McDonald versus modified Shirodkar rescue cerclage in women with prolapsed fetal membranes
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2018
We compared the efficacy of modified Shirodkar and McDonald rescue cerclage techniques in women with singleton pregnancies. The study sample included 47 women who presented at two tertiary hospitals in Turkey from 2008 to 2017 and underwent rescue cerclage due to cervical incompetence and cervical dilatation with fetal membranes prolapsed into the vagina. The outcomes were compared by cerclage technique used, Shirodkar or McDonald. The McDonald cerclage was applied in 27 cases, and modified Shirodkar cerclage in 20 cases. A longer cerclage-to-birth interval (83.8 ± 37.6 vs. 63.7 ± 38.9 days) and later gestational age at delivery (33 vs. 31 weeks) were observed with the Shirodkar cerclage, although these differences were not statistically significant (p = .08 and .63, respectively). Both groups had similar delivery rates after 28, 32, and 37 weeks (p = .20, .15, and .25, respectively), whereas the modified Shirodkar technique resulted in a higher rate of live births although these di...
Pregnancy outcomes following placement of elective, urgent and emergent cerclage
The Journal of Maternal-Fetal & Neonatal Medicine, 2009
Objective. To describe pregnancy outcomes following elective (history-indicated), urgent (ultrasound-indicated) or emergent (physical-exam indicated) cerclage placement. Materials and Methods. Study design was retrospective chart review. Women with singleton gestation and cervical cerclage were categorised into: elective, urgent and emergent group. Results. One hundred and thirty-three women were included; 89 in elective, 26 in urgent and 18 in emergent group. Difference was detected when elective and urgent groups were compared with emergent group for: gestation at delivery (35.9 + 5.1 vs. 34.2 + 5.9 vs. 29.3 + 7.2 weeks, respectively, P 5 0.05), delivery beyond 36 weeks, (73.9%, 57.7% vs. 23.5%, respectively, P 5 0.05), neonatal death (6.8%, 9.5% vs. 43.8%, respectively, P 5 0.05) and Apgar score 57 at 5 min (9.1%, 11.5% vs. 47.1%, respectively, P 5 0.05). Difference was also detected between elective vs. urgent and emergent groups for: preterm premature rupture of membranes (PPROM) (19.3% vs. 38.5% vs. 64.7%, respectively, P 5 0.05) and chorioamnionitis (1.4% vs. 18.2% vs. 42.9%, respectively, P 5 0.05). Conclusions. Emergent cerclage group had the poorest obstetric outcomes. The urgent cerclage group reached similar gestational age at delivery as the elective group but is more likely to have PPROM and chorioamnionitis.
American Journal of Perinatology Reports, 2012
Pregnancies complicated by midtrimester painless cervical dilation are known to have associations with preterm birth. In situations where fetal amniotic membranes are exposed, the risk of perinatal morbidity and mortality increases dramatically in this particularly high-risk population. Multifetal gestations further increase the risk of preterm birth, yet there remains a paucity of data supporting therapeutic intervention for these patients. We report a case series of 12 multifetal gestations with painless cervical dilation and exposed fetal membranes that underwent emergency cerclage placement. Pregnancy prolongation was achieved on average 60.25 days with 76.9% neonatal survival. These findings are suggestive that emergency cerclage may be a beneficial treatment in this unique patient population.
Contemporary Use of Cerclage in Pregnancy
Clinical Obstetrics & Gynecology, 2009
Second trimester pregnancy loss and preterm delivery may be considered an obstetrical syndrome. A multifactorial approach to the diagnosis of true cervical insufficiency is paramount. Surgical modification of the cervix benefits those with at least 3 second trimester losses or preterm deliveries, those with 2 early second trimester losses when no other cause for loss is identified, and those with a previous second trimester loss or preterm birth with ultrasound findings of a short cervix defined as less than 25 mm. Multifetal pregnancies do not benefit from cerclage and causes harm in those with ultrasound or physical examination identified cervical changes.
Favorable outcome following emergency second trimester cerclage
International Journal of Gynecology & Obstetrics, 2007
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.