Abstract
Emergency cerclage with advanced cervical dilatation and bulging of fetal membranes is still challenging to obstetricians. Objective: To identify the live birth rate after physical examination indicated rescue cerclage. Methods: A retrospective cohort study of 36 pregnant women, who underwent rescue cerclage at Hung Vuong hospital from January 2015 to January 2019. Selection criteria: cervical dilation 10 to 40 mm, at 20 to 30 gestational weeks. Exclusion criteria: multiple pregnancy, birth defects, pregnancy termination due to maternal or fetal indications. Results: Delivery of live infant rate was 72.22%; mean pregnancy prolongation was 42.8 ± 34.15 days. Early live birth rate was 77.78%. The percentage of delivery after 34 and 37 weeks was 44.45% and 27.78%, respectively. Live birth weight was 400 to 3600 g, with mean being 1878.06 ± 1049.04 g. No procedure-related complication was observed. Conclusions: Rescue cerclage may be an effective and safe method in prolonging pregnancy and improving neonatal outcome in women with cervical dilation 10 to 40 mm. It should be considered as a viable option for women with a dilated cervix in 20 to 30 gestational weeks. Future controlled studies are needed.
Highlights
Cervical insufficiency is an incomplete condition of the uterus cervix, resulting in extremely premature birth or late abortion in the absence of signs of uterine
Cervical insufficiency can lead to extremely premature birth, leading to increased neonatal mortality and morbidity
Cervical cerclage with cervical insufficiency is a practical issue in pregnancy management
Summary
Cervical insufficiency is an incomplete condition of the uterus cervix, resulting in extremely premature birth or late abortion in the absence of signs of uterine. The use of cervical cerclage in the prevention of preterm delivery was described by Shirodkar in 1955 and by McDonald two years later It is not clear why dilatation and effacement of the cervix occur prematurely, but it is thought that the forced mechanical closure of an “incompetent” cervix with a suture maintains the cervical length as well as the mucus plug—both of which have a role in preventing labour. A retrospective study in China of 10 years on 158 cases of suturing when the cervix was open, and the amniotic sac was seen, showed that this technique helped prolonging pregnancy by an average of 52.16 ± 6.2 days, with the infant survival rate is 82.28% [5]. This information may help the patient and her career make an informed decision about whether to undergo emergency procedure
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