How can we improve the outcome of emergency cerclage?

Abstract

Cervical insufficiency is a well-recognized cause of preterm birth in the second or early third trimester of pregnancy, and therefore it is very important topics related to preterm birth. Cervical insufficiency with bulging fetal membranes during the second trimester is a serious complication, often leading to still birth or preterm delivery. [1] Emergency cerclage is recognized as an essential procedure for prolonging gestation in women with advanced cervical changes and/or prolapsed membranes in the second trimester. Many studies report that women presenting with advanced cervical dilation may benefit from emergency cerclage [2–8]. Namouz et al. [9] reviewed 34 studies in literature and found that, in observational and limited randomized control trials, the cerclage groups did significantly better than the bedrest groups in terms of mean randomization-to-delivery interval, preterm delivery before 34 weeks, and compound morbidity. Hashim et al. [10] retrieved 141 articles related to emergency cerclage and also found current evidence to show the benefits of emergency cerclage. It may prolong pregnancy by an average 4–5 weeks, with a two-fold reduction in the possibility of preterm birth before 34 weeks of pregnancy. The rate of emergency cerclage success is relatively low, however, certainly compared with elective cerclage. Membranes are easily ruptured intraoperatively, especially when the cervix is widely dilated and the fetal membranes are prolapsed beyond the cervix [5, 6]. Pushing bulging fetal membranes back into the uterine cavity during cerclage with a sponge swab or Foley catheter is difficult. Overfilling the urinary bladder to reduce