Emergency Cerclage Research Articles

Vancomycin-Resistant Enterococci and Extended-Spectrum β-Lactamase-Producing Bacterial Colonization of the Cervix after Emergency Cerclage: Is It Safe?

Antimicrobial resistance is currently becoming a global threat to human health. We performed a retrospective study on patients who underwent emergency cerclage between January 2016 and December 2018 at the Dongsan Medical Center. Cervical culture was first performed before surgery to confirm that there was no infection and was repeated on days 1, 4, and 7 after surgery. A total of 85 pregnant women underwent emergency cerclage. Among them, six patients had vancomycin-resistant enterococci (VRE) colonization in the cervix after cerclage, and 23 patients developed extended-spectrum β-lactamase (ESBL)-producing bacterial colonization in the cervix. The average gestational age at delivery was lower in the VRE group. Neonatal death was also significantly higher in the VRE group. The rate of occurrence of early-onset sepsis was also higher in the VRE group, and both VRE and ESBL-producing bacterial colonization cases in which early-onset sepsis occurred resulted in neonatal death. The prognosis of cervical VRE colonization after cervical surgery was poor, whereas the prognosis of ESBL-producing bacterial colonization in the cervix did not differ significantly from that of the control group. However, careful neonatal treatment is required considering that early-onset sepsis is fatal to the newborn.

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes.

To determine the effect of mid-trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28weeks, after cerclage. Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015-2020). The primary outcomes were the rate of sPTB before 28weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28weeks, after cerclage. Ninety-seven women were included, cerclage (n=58) or no cerclage (n=39). Cerclage placement was associated with significantly lower incidence of sPTB before 28weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71±27.52 vs 10.95±11.71days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82-62.95), pregnancy duration at diagnosis less than 22weeks (OR 9.42; 95% CI 1.69-52.69) and cervical dilation at least 4cm (OR 7.92; 95% CI 1.40-44.71) were found to be independent risk factors for sPTB before 28weeks, after cerclage. Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28weeks and a prolongation of latency by 5weeks. The strongest predictor of sPTB before 28weeks after cerclage was a positive cervical culture.

Shirodkar cerclage: Obstetrical and neonatal outcomes in a single-center cohort of 55 cases

BackgroundCervical insufficiency is thought to be responsible for 10% of preterm deliveries. Shirodkar cerclage is among the available techniques ranging from McDonald's to definitive procedures, however the indications for the prevention of preterm births and mid-trimester miscarriages are still poorly delineated. ObjectiveTo describe the characteristics, obstetrical and neonatal outcomes of pregnancies with Shirodkar cerclage procedures. MethodWe performed a descriptive retrospective single-center study, including all patients who had a Shirodkar cerclage between January 1, 2008 and December 31, 2020. The main outcomes measured were delivery at or beyond 24 and 32 weeks of gestations (WG). Results55 Shirodkar cerclages were performed over the period studied. 7.3% of patients had a uterine malformation, 9% had a history of cervical conization. 74.5% had history of one or more mid-trimester miscarriages. 63.6% had a history of a failed emergency or prophylactic cerclage. The median gestational age (GA) at cerclage placement was 14 WG. There were 4 deliveries before 24 WG, 8 before 32 WG and 16 before 37 WG. Overall neonatal survival was 48/53 (90.6%). The median GA at delivery was 38 weeks (IQR 35–39), with 70.3% of vaginal deliveries. ConclusionShirodkar cerclage was successful in more than 90% of patients, despite their obstetric history. Shirodkar cerclage may be indicated in the event of prior cerclage failure using the McDonald technique or in order to allow for correct stitch placement in very short cervixes. Its advantage over definitive cerclage is to allow for vaginal delivery.

Painless cervical dilation with "hourglass membranes": conservative management.

Cervical competence is currently conceived as a continuous biological process with progressive degrees of insufficiency, this substituting the traditional vision of cervical competence as being present or absent. The most extreme expression of cervical insufficiency is known as "hourglass membranes". Currently no consensus exists regarding the treatment of pregnancies complicated by the protrusion of amniotic membranes; however, the majority of authors agree on recommending bed rest and performing cervical cerclage, known as "emergent cerclage." We describe a series of clinical cases corresponding to second-trimester pregnancies with cervical dilation and prolapsed amniotic membranes that were admitted to our hospital, managed with conservative treatment. All patients received the same basic treatment: intravenous fluid therapy for hydration, a single-oral-dose of azithromycin and intravenous antibiotic therapy for 7 days, vaginal micronized progesterone and indomethacin administrated orally. Mean gestational age at diagnosis was 22.5 weeks with an extension of pregnancy between 2.1 and 16 weeks, with eight patients (72.72%) who extended their pregnancy for more than 8 weeks. In all cases, live fetuses were obtained, with favorable evolution. Despite our limited experience, resulting from the low number of cases presenting, our results encourage us to propose conservative management in pregnancies complicated with a dilated cervix and membranes protruding into the vagina, as a reasonable alternative to surgical emergency cervical cerclage, which is currently considered the therapy of choice when extreme cervical shortening occurs in the second trimester of pregnancy.

Analysis of Elective and Emergency Cerclage Practice in Terms of Perinatal Results

Amaç: Sevk alan üçüncü basamak merkezimizde yapılan elektif ve acil servikal serklaj sonuçlarını incelemeyi ve etkinliklerini değerlendirmeyi amaçladık
 Gereçler ve Yöntem: Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde Ocak 2016 ile Ocak 2020 arasında servikal yetmezlik tanısıyla servikal serklaj yapılan toplam 56 hastanın sonuçları retrospektif olarak incelenmiştir. Transvajinal olarak Mc-Donald tipi serklaj uygulanan hastalar çalışmaya dahil edilmiştir. Çoğul gebeliği olan, abdominal serklaj uygulanan ve doğum sonuçlarına ulaşılamayan hastalar çalışma dışı bırakılmıştır. Serklaj yapılma endikasyonuna göre hastalar; elektif serklaj (öykü endikasyonlu) ve acil serklaj (fizik muayene ve ultrasonografi endikasyonlu) olmak üzere iki grupta incelenmiştir. 
 Bulgular: Serklaj işleminin yapıldığı gebelik haftası elektif ve acil grupları için sırasıyla 20.8±0.7 ve 13.9±0.1 hafta olarak saptandı. Elektif serklaj yapılan grupta serklaj işlemi ile doğum arasında geçen süre ile doğumun gerçekleştiği hafta belirgin olarak daha fazlaydı (151.1±6.5 gün / 35.2±0.9 hafta vs 23.7±18.5 gün / 26.6±1.4 hafta ). Bununla ilişkili olarak da doğum ağırlığı elektif serklaj yapılan grupta acil serklaj yapılan gruptan anlamlı olarak daha fazlaydı ( 2913.7±129 gr vs 1611.4±232.2 gr). Yenidoğan yoğun bakım gereksinimi ise elektif serklaj grubunda daha azdı. Doğum şekli ve abortus oranı açısından ise her iki grup arasında istatiksel anlamlı fark yoktu.
 Sonuç: Ağrısız servikal açıklık ile başvuran ya da ultrasonografide belirgin kısa servikse sahip hastalarda yapılan acil serklaj da elektif serklaj kadar olmamakla birlikte gebelik süresini uzatmada ve kötü perinatal sonuçları azaltmada etkilidir. Elektif serklaja kıyasla acil serklaj etkinliğini belirlemek için acil serklaj uygulanan hastaların daha iyi randomize edildiği daha fazla hasta sayısı ile yapılacak prospektif çalışmalara ihtiyaç vardır.

Emergency Cervical Cerclage.

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.

Prevention of preterm delivery by cervical cerclage; a comparison of prophylactic and emergency procedures

Objective:Prophylactic or emergency type cervical cerclage procedures are being used for treatment of cervical insufficiency. The aim was to review and compare the outcomes of these cerclage types and identify factors affecting outcomes.Material and Methods:Retrospective review of seventy-five patients in whom transvaginal cervical cerclage procedures were performed over a seven-year period in a tertiary referral center.Results:Twenty seven of 75 (36%) patients were in the emergency cerclage group and 48 (64%) of them were in the prophylactic group. Mean body mass index (BMI), hospitalization time and gestational week at cerclage were significantly higher, whereas latency period was significantly shorter for the emergency group. Mean gestational ages at delivery were 35.6±4.5 and 33.6±5.9 weeks in the prophylactic and emergency groups, respectively (p=0.117). Delivery rates under 34th gestational week were 20.8% and 37.0% in the prophylactic and emergency groups, respectively (p=0.175). Birthweight, and delivery ≥34th gestational week was higher in the prophylactic group, whereas complication rate was higher in the emergency group, but these differences were not significant. High BMI was associated with more deliveries before 34-week in the prophylactic group. Pre-cerclage cervical length was shorter in patients who delivered before 34 gestational weeks at delivery.Conclusion:Prophylactic and emergency cerclage procedures have comparable results regarding gestational week at delivery. High BMI and low pre-cerclage cervical length may have adverse effects on success of cerclage procedures.

A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies.

To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies. A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome. There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery. The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.

Pregnancy Outcomes After Emergency Cerclage For Cervical Insufficiency A Retrospective Study

Aim: Evaluation of maternal and fetal outcomes, effectiveness and reliability of the cerclage for the emergently cerclaged cases due to cervical insufficiency &#x0D; Materials and Methods: Clinical data from live singleton pregnancies who were diagnosed cervical insufficiency were reviewed retrospectively between the Feb 2010-Jan 2019, at Acıbadem University and Mersin University, Department of Obstetrics and Gynecology. &#x0D; Results: During the study period, total 29 cervical cerclage operation was performed by McDonald technique. Mean maternal age 31.82±4.449 years (21–38), mean gestational age at diagnosis and cerclage placement was 22.17±2.071 weeks (18-28). Take home baby rate was 79.3 % (n=23). Mean time interval between the cerclage and the birth is 9.24±5.723 weeks (0-18), mean pregnancy week during the birth is 31.4±5.02 weeks (23-39) and mean birth weight is 1873±903 g (650-3782). There was no surgical complication reported from the studied population. Thirty percent (9) of the patients were delivered by C-section.&#x0D; Discussion: Emergency cerclage prolongs the pregnancy duration of the women with cervical insufficiency, and has marked effects on improving the neonatal outcomes. It is thought to be an appropriate choice for the women with cervical dilatation at the earlier pregnancy weeks.

Endikasyonlarına göre servikal serklaj uygulamasının perinatal ve neonatal sonuçlar üzerine etkisi

Objective: The aim was to investigate the perinatal and neonatal outcomes in the cases which underwent cervical cerclage, and to compare the elective and emergency cerclage cases. Methods: The cases that underwent cervical cerclage in the Hospital of the Faculty of Medicine at Akdeniz University between January 2014 and December 2019 were assessed retrospectively, and separated into 3 categories as the prophylactic, elective and emergency groups. The demographic characteristics and perinatal and neonatal outcomes were recorded and they were compared between the groups. Results: A total of 92 cases with singleton pregnancy between 12 and 24 weeks of gestation were included in the study. The prophylactic cerclage group consisted of 48 cases, the elective cerclage group consisted of 21 cases and the emergency cerclage group consisted of 23 cases. The rate of the cases delivered at term (≥37 weeks of gestation) was found significantly lower in the emergency cerclage group than the rates of the cases in the prophylactic and elective cerclage groups (26.1%, 70.8% and 66.7%; respectively). While there was no significant difference between the prophylactic and elective cerclage groups in terms of premature preterm labor (&lt;32 weeks of gestation), the rate of premature preterm labor was significantly higher in the emergency cerclage group than two other groups (10.4%, 9.5% and 43.5%, respectively; p=0.005). The mean delivery week of the emergency cerclage cases was significantly higher than the prophylactic and elective cerclage groups (31.7, 36.7 and 36.5 weeks, respectively; p&lt;0.001). The mean duration between the cerclage procedure and the delivery week was the highest in the prophylactic cerclage cases and the lowest in the emergency cerclage cases (22.8 and 9.7 weeks, respectively; p&lt;0.001). The mortality rate of the newborns was higher in the emergency cerclage cases than the other groups, which was statistically significant (p=0.002). Conclusion: We concluded that the perinatal and neonatal outcomes of the emergency cerclage procedure carried out in the advanced stage of cervical changes in the cases with cervical insufficiency is less successful than the prophylactic and elective cerclage procedures. The early detection of cervical insufficiency by the previous history, the physical examination and the measurement of transvaginal cervical length and responding at the early weeks of gestation may improve the perinatal and neonatal outcomes.

Dev servikal myomu olan gebelikte başarılı servikal serklaj uygulanması

Cervical insufficiency or early cervical dilation is a fundamental cause of second-trimester pregnancy loss. Cervical cerclage is the principal treatment for women with cervical insufficiency. Uterine myoma is the most common benign gynaecologic tumour, occurring in approximately 20% of reproductive age women, whereas uterine cervical myoma is rare and constitutes 5% of all myomas. One of the most important aetiological factors for premature labour is cervical insufficiency. Emergency cerclage can be effective, although according to the literature cerclage placement as a means of prolonging the duration of pregnancy has provided conflicting results. Here, we aimed to present successful implementation of cerclage process in a pregnant patient with a large cervical myoma.

Balloon tamponade for successful emergency cervical cerclage.

To illustrate the method of emergency cerclage with the balloon tamponade and demonstrate the efficacy of this surgery method. Procedures of the balloon tamponade assisted emergency cerclage were reviewed in detail and outcomes of 39 patients treated with this way were evaluated. From 2017 to 2019, emergency cerclage was successfully performed in 39 patients with a dilated cervix and bulging fetal membranes, assisted by the balloon tamponade. The diameter of the bulging prolapsed membranes ranged from 0.0-10.0 cm, with a median of 2.0 cm. Prolongation of the pregnancy period was from 8 to 138 days, with a median of 29 days. No maternal complications including infections, cervical laceration and cervical bleeding were observed perioperative period. Emergency cerclage is an effective way to prolong gestational period in patients with advanced cervical dilatation and bulging membranes. The balloon tamponade assisted emergency cerclage makes the replacement of fetal membranes back into the uterine cavity easier and effectively, then a successful and convenient emergency cerclage can be performed.

Proteomic Analysis of Amniotic Fluid Proteins for Predicting the Outcome of Emergency Cerclage in Women with Cervical Insufficiency.

We aimed to identify novel biomarkers in amniotic fluid (AF) that predict the outcome of emergency cerclage in women with cervical insufficiency. This retrospective cohort study included 40 singleton pregnant women who received emergency cerclage for cervical insufficiency (17-25weeks) and underwent amniocentesis. Label-free liquid chromatography-tandem mass spectrometry (LC-MS/MS) was used to identify AF proteins in pooled samples (n = 16) using a nested case-control approach. The six candidate biomarkers of interest were validated by enzyme-linked immunosorbent assays (ELISA) in the final cohort (n = 40). The differentially expressed proteins (DEPs) were analyzed by pathway analysis software. The primary outcome measure was failure of emergency cerclage [defined as spontaneous preterm delivery (SPTD) at < 34weeks of gestation after cerclage placement]. Sixty-eight proteins were differentially expressed (P < 0.001) in AF from SPTD cases and near-term controls, of which 44 (64.7%) were upregulated and 24 (35.3%) were downregulated. Validation by ELISA confirmed that AF from women with cerclage failure contained significantly higher levels of myeloperoxidase, lactoferrin, glucose-6-phosphate isomerase, lipocalin-2, and lymphocyte cytosolic protein 1, the first four of which were independent of cervical dilatation at presentation. The five pathways with the most differentially regulated proteins were actin cytoskeleton signaling, acute phase response signaling, ILK signaling, glycolysis, and gluconeogenesis. Proteomic analyses of AF in this study identified DEPs and specific protein pathways related to poor prognosis after emergency cerclage for cervical insufficiency. Four novel independent biomarkers in AF for cerclage failure have been identified using proteomics.

Outcomes of prophylactic and emergency cerclage versus expectant management for cervical insufficiency: a single-center retrospective, comparative study

Aim: To compare the outcomes after prophylactic cerclage, emergency cerclage, and expectant management in women with cervical insufficiency. Materials and Methods: From 2011 to 2015, Eulji University Hospital’s database was retrospectively analyzed to identify women with cervical insufficiency without premature rupture of membranes (PROM), clinical chorioamnionitis, or labor pain from 12 to 26 weeks of gestation. Gestational age at delivery, term delivery rate, after-34-weeks-of-gestation delivery rate, intensive-careunit admission rate, neonatal sepsis, and neonatal mortality rate were compared between each group. Results: Forty-eight women underwent prophylactic cerclage: 56 emergency cerclage and 21, expectant management. Prolongation of pregnancy was longer in the prophylactic cerclage group than in the emergency group (22.8 ± 2.7 weeks vs. 13.3 ± 6.1 weeks, p &lt; 0.001). Preterm delivery rate &lt; 34 gestational weeks was significantly higher in the emergency cerclage group than the prophylactic group (37.5% vs. 14.6%, p = 0.009). Elevated pre-cerclage C-reactive protein (CRP) was associated with delivery before 34 weeks in the emergency cerclage group [odds ratio (OR): 15.849; 95% confidence interval (CI): 1.289-194.898, p = 0.031]. Comparing the emergency cerclage and expectant groups, prolongation of pregnancy was higher in the emergency group than the expectant group (13 ± 6.1 weeks vs. 8 ± 5.7 weeks, p = 0.002). However, there were no significant differences between the two groups regarding preterm delivery &lt; 34 weeks and perinatal outcomes. Conclusions: Preterm delivery rate &lt; 34 gestational weeks was higher in the emergency cerclage group than the prophylactic group. There were no significant differences between the emergency cerclage and the expectant groups in pregnancy and perinatal outcomes.

Effect of Cervical Cerclage on the Risk of Recurrent Preterm Birth after a Twin Spontaneous Preterm Birth.

BackgroundThis study aimed to evaluate the effect of cervical cerclage on the recurrence risk for preterm birth in singleton pregnant women after a twin spontaneous preterm birth (sPTB).MethodsThis multicenter retrospective cohort study included women who had a singleton pregnancy from January 2009 to December 2018 at 10 referral hospitals and a twin sPTB before the current pregnancy. We compared the cervical lengths during pregnancy and pregnancy outcomes, according to the placement of prophylactic or emergency cerclage. We evaluated the independent risk factors for sPTB (< 37 weeks of gestation) in a subsequent singleton pregnancy.ResultsFor the index singleton pregnancy, preterm birth occurred in seven (11.1%) of 63 women. There was no significant difference in the cervical lengths during pregnancy in women with and without cerclage. In a multivariate logistic regression analysis, the placement of emergency cerclage was an independent risk factor for subsequent singleton preterm birth (odds ratio [OR], 93.188; 95% confidence interval [CI], 1.633–5,316.628; P = 0.027); however, the placement of prophylactic cerclage (OR, 19.264; 95% CI, 0.915–405.786; P = 0.057) was not a factor. None of the women who received prophylactic cerclage delivered before 35 weeks' gestation in the index singleton pregnancy.ConclusionCerclage did not lower the risk of preterm birth in a subsequent singleton pregnancy after a twin sPTB. However, emergency cerclage was an independent risk factor for preterm birth and there was no preterm birth before 35 weeks' gestation in the prophylactic cerclage group. Therefore, close monitoring of the cervical length and prophylactic cerclage might be considered in women who have experienced a twin sPTB at extreme gestation.

Physical Examination Indicated Rescue Cerclage to Improve Live Birth Rate at Hung Vuong Hospital in Vietnam

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.

The use of quantitative fetal fibronectin for the prediction of preterm birth in women with exposed fetal membranes undergoing emergency cervical cerclage

ObjectiveEmergency cervical cerclage is often considered a controversial salvage measure for those pregnancies at high risk of mid-trimester loss or early preterm birth. To determine the efficacy and benefit of emergency cerclage insertion, we assessed the predictive value of quantitative fetal fibronectin (fFN) concentration in cervicovaginal fluid for spontaneous preterm birth in women with exposed fetal membranes prior to cerclage insertion. Study designThis was a retrospective observational study from St Thomas’ Hospital, London of a cohort of women with singleton pregnancy and exposed fetal membranes presenting between 18 and 23+6 weeks of gestation (n = 35), in the period 2015-2018. fFN concentrations in cervicovaginal fluid were measured quantitatively at presentation in all women within 24 h prior to cerclage insertion. Results35 eligible women with exposed fetal membranes who underwent an emergency cervical cerclage were identified. The median gestational age was 20 + 0 weeks (18 + 6−21 + 2) at presentation and 29 + 3 weeks (23 + 3−38 + 2) at delivery, with a median time from emergency cerclage to delivery of 65.5 days (17–126.5). In total, 12 women (34 %) delivered within 28 days of emergency cerclage insertion. 60 % of women with an fFN level above 500 ng/mL delivered within 28 days of cerclage insertion, and they all delivered before 37 weeks gestation. No women with fFN levels below 10 ng/mL delivered within 28 days and 75 % of these women delivered at term. Concentration of quantitative fFN at presentation correlated negatively with time to delivery (Spearman's rs = −0.52, p = 0.0016). Mann–Whitney U analysis demonstrated a significant difference in the distribution of qfFN concentrations in women who delivered preterm compared to those who did not, both within 28 days from testing (p = 0.0048) and <37 weeks (p = 0.006). ConclusionQuantitative fFN has a role in predicting spontaneous preterm birth even in women with exposed fetal membranes undergoing emergency cervical cerclage. Given the serious risks associated with cervical cerclage surgery, qfFN could be used to counsel these patients at high risk of preterm delivery, as well as assisting in the decision to insert a cerclage.

Emergency cerclage following a standardized protocol offers an effective and safe therapeutic option for women with high risk for prematurity – a retrospective monocentric cohort study on 130 pregnancies and 155 neonates

Objective To present emergency cerclage (EC) as a safe and effective therapeutic option for prevention of prematurity in women with advanced cervical dilation in second-trimester pregnancy. It is focused on seemingly futile situations like cervical dilation >5 cm, bulging membranes and multifetal pregnancies. The outcomes of interest are the prolongation of pregnancy, gestational age at delivery and neonatal morbidity and mortality related to distinct risk factors. Study design Retrospective monocentric cohort study involving 130 pregnancies (105 single and 25 twin pregnancies) and 155 neonates by using a standardized protocol. Women between 18 and 28 gestational weeks with cervical shortening of <10 mm + cervical dilation >2 cm and/or bulging membranes were included. Analyses of maternal and neonatal parameters were done by chart review. Results The medium gestational age at delivery was 35 5/7 week with a medium interval from cerclage placement to delivery of 83 days. Overall, 46.5% (72/155) neonates were born beyond 37 weeks, extreme prematurity of less than 28 gestational weeks was observed in 14.8% (23/155), no miscarriage before 22 weeks was documented. The neonatal mortality was 1.9% (3/155). Neonatal deaths and morbidity was related to severe prematurity exclusively. The association of amnion-infection syndromes and failing therapy was significantly with respect to bulging membranes and advanced cervical dilation >5 cm. Conclusions Even in futile cases EC can be an option to save the pregnancy and prevent severe prematurity. However, a standardized protocol is imminent for successful therapy and every indication has to be a case by case decision.

P19.08: Emergency cerclage with no residual cervical length on ultrasound: when does it work?

P19.08: Emergency cerclage with no residual cervical length on ultrasound: when does it work?

Emergency cerclage: gestational and neonatal outcomes.

The gestational and neonatal outcomes of women with early cervical dilatation undergoing emergency cerclage were evaluated and compared with women treated with expectant management and bed rest. Retrospective analysis of pregnant women admitted between 2001 and 2017 with a diagnosis of early cervical dilatation and/or bulging membranes. Patients with a singleton pregnancy of a fetus without malformations, between 16 and 25 weeks and 6 days, with cervical dilatation of 1 to 3 cm were included; patients who delivered or miscarried within 2 days after admission were excluded. The study enrolled 30 patients: 19 in the cerclage group and 11 in the rest group. There was a significant difference, with the cerclage group showing better results concerning gestational age at delivery (28.7 vs. 23.3 weeks; p=0.031) and latency between hospital admission and delivery (48.6 vs. 16 days; p=0.016). The fetal death rate was lower in the cerclage group (5.3% vs. 54.5%, p=0.004). Considering gestational age at delivery of live newborns, no difference was observed between the cerclage and rest groups (29.13 vs. 27.4 weeks; p=0.857). Emergency cerclage was associated with longer latency, a significant impact on gestational age at delivery and reduction in the fetal death rate.