Abstract
Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem. The reasons for recurrent pregnancy loss and preterm delivery are diverse and multifactorial. One of the main reasons for these complications is cervical insufficiency, which means that the cervix is weak and unable to remain closed until the date of delivery. It manifests as painless softening and shortening of the cervix without contractions. The aim of the study was to review the available literature on rescue sutures, which are an emergency treatment in pregnancies with premature cervical dilatation and protrusion of the fetal membranes in the second trimester of pregnancy. This review confirms that emergency cerclage reduces the rate of preterm birth in patients with advanced cervical insufficiency. This procedure prolongs gestational age and improves the chances of survival of the newborn without increasing the risk of chorioamnionitis and preterm premature rupture of membranes.
Highlights
Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem [1,2,3]
In a large Danish register-based cohort study Sneider et al [16] found that the overall recurrence rate of second trimester miscarriage or extreme preterm delivery (16+0 to 27+6 gestational weeks) was 7%, but it differed significantly by phenotype
In the Danish study, prophylactic cerclage applied before 16 weeks of gestation was associated with a significant reduction in recurrence rate of second trimester miscarriage or extreme preterm delivery [16]
Summary
Despite the progress of medicine in the last decades, recurrent pregnancy loss, premature birth, and related complications are still a vast problem [1,2,3]. The incompetent cervix is a well-recognized cause of midtrimester miscarriage, recurrent pregnancy loss in the mid-trimester, and preterm labor presenting with bulging membranes in the absence of significant uterine contractility or rupture of membranes [14]. In the Danish study, prophylactic cerclage applied before 16 weeks of gestation was associated with a significant reduction in recurrence rate of second trimester miscarriage or extreme preterm delivery [16]. Cervical dilatation and protrusion of the fetal membranes in the second trimester of pregnancy put pregnant women at high risk of miscarriage or premature birth. A rescue cerclag emergency treatment, which extend the duration of pregnancy [38]. 3 of 12
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