Infant outcomes following midtrimester emergency cerclage in the presence of fully dilated cervix and prolapsing amniotic membranes into the vagina

Abstract

Objective: To investigate the morbidity of infants, whose delivery was prolonged by an emergency cervical cerclage (EC). Methods: Ante- and postnatal data on subsequent EC procedures performed between 14 and 28 weeks of gestation for advanced cervical dilatation with prolapsing of amniotic membranes at a single institution within a 5-year-period were retrieved. Results: We identified 21 fetuses from 18 pregnancies. Median gestational age [interquartile range, IQR] at EC and prolongation of pregnancy was 21.5 [15–26] weeks and 49.3 [24–92] days, respectively. There were 4 (19%) stillbirths, 3 (14%) neonatal deaths, and 1 (5%) infant death. Ten infants (59% of livebirths) were admitted to neonatal intensive care unit and hospitalized for a median period of 11 [6–66] d. Of the surviving fetuses (14/21, 66.7%), 9 (42.8%) were intact, whereas 3 (17.6% of livebirths) had cerebral palsy (CP), 1 was diagnosed with hypothyroidism, and another had growth failure at 12 months of follow-up. Conclusion: EC seems to be beneficial only in a subset of pregnancies presenting with full cervical dilatation accompanied by prolapsing amniotic membranes into the vagina, and there is a requirement for more objective selection criteria. Neonatal morbidity, especially neurodevelopmental disability should be discussed thoroughly prior to this procedure.