Foley Balloon Research Articles

Anterior and Posterior Bladder Neck Dissection with Tension Stitch

Abstract Introduction: In this video, we demonstrate both the anterior and the posterior bladder neck dissection with tension stitch. Placing a suture in the posterior bladder neck is a common approach in patients with median lobes, whereby the median lobe is retracted with a figure-of-eight suture. Materials and Methods: The 30-degree down lens is utilized for the most optimal view of this dissection. Results: Multiple visual cues are utilized to determine the location of the bladder neck, including the limits of the anterior prostatic fat pad, excursions of the Foley balloon, and tissue response to pinching maneuvers. The initial dissection focuses primarily in the midline, aiming to get down to vertical fibers, which appear just before the catheter is exposed. If the lateral contours of the prostate are readily apparent, this tissue may be taken down as well, bearing in mind that bleeding is often encountered laterally as shown. Once the catheter is exposed, some lateral progression will help define th...

Predictors of cesarean delivery in women undergoing labor induction with a Foley balloon

Objective: To examine predictive characteristics for cesarean delivery (CD) in women undergoing labor induction with a Foley balloon (FB).Methods: A secondary analysis of a randomized, double-blind, control trial examining labor induction with a transcervical 30 mL or 60 mL FB. One-hundred ninety-nine women with term, vertex, singleton pregnancies and Bishop score < 5 were randomized to receive a transcervical 30 mL or 60 mL FB. Mode of delivery, labor complications and neonatal outcomes were recorded. A multivariable model was performed to determine predictive characteristics for CD.Results: Increasing maternal age (p = 0.04), nulliparity (p =0.002) and chorioamnionitis (p < 0.001) were significantly associated with an elevated risk for CD. Nulliparity was associated in an almost 4-fold increased CD risk (relative risk [RR]: 3.88; 95% confidence interval [CI]: 1.22–12.3). Women aged ≥ 40 years, had an almost 3-fold increased risk of CD as compared to women aged 20–29 (RR: 2.91; 95% CI: 1.36–6.19) years. Chorioamnionitis was associated with nearly a 2-fold increased risk for CD (RR: 1.87; 95% CI: 1.06–3.32). A gestational age of ≥ 41 weeks, prostaglandin use during induction and induction indication did not affect mode of delivery.Conclusion: In patients undergoing labor induction with a FB, increasing maternal age, nulliparity and chorioamnionitis are associated with an elevated risk for CD.

Image-Guided Sharp Recanalization of a Benign J Pouch Anastomotic Occlusion Facilitates Surgical Repair

A 27-year-old man with a 9-year history of ulcerative colitis who had undergone total proctocolectomy with construction of a continent pouch in 2008 presented 1 year later with occlusion of the ileal pouch–anal anastomosis precluding ileostomy closure. An attempt at surgical reconstruction at an outside hospital failed, and the patient was informed that he would have a permanent stoma. A further attempt at blind surgical recanalization of the occlusion risked sphincter damage and was deferred. In 2010, reconstruction was performed using a hybrid approach combining image-guided sharp recanalization of the occluded anastomosis with positioning of a large-diameter Foley balloon catheter across the recanalized segment, followed by immediate surgical revision of the J pouch. Ileostomy closure was performed 1 month later. Continence was preserved. Surgical repair preceded by sharp recanalization with positioning of a balloon catheter across the occluding membrane may safely regain durable patency in a chronically occluded ileal pouch–anal anastomosis.

A novel steerable Foley balloon catheter for preventing phrenic nerve injury during epicardial catheter ablation

A 69-year-old man with a history of dilated cardiomyopathy underwent epicardial catheter ablation of repetitive ventricular tachycardia through a subxiphoid pericardial window. A perfect pace map was obtained at the lateral aspect of the left ventricular epicardium, but it was accompanied by phrenic nerve capture. We combined a 14-French Foley balloon catheter with a 5French steerable mapping catheter, (Fig. 1). The Foley balloon was then advanced into the pericardial space and navigated into position near the site of perfect pace map using the steerable mapping catheter. During the high-output pacing from the ablation catheter, the Foley balloon was inflated and resulted in the absence of phrenic nerve capture (Fig. 2). With the balloon inflated, irrigated radiofrequency current was delivered at that site. After the ablation, normal function of the left diaphragm was verified by fluoroscopy.

長期間の膀胱内バルーンカテーテル留置により発症した膀胱S状結腸瘻の1例

症例は86歳の女性で，85歳時に神経因性膀胱による膀胱破裂に対し当科で破裂部の縫合術を施行し，術後は経尿道的な膀胱内バルーンカテーテルの留置による減圧治療で経過観察中であった．経過観察中に尿に便が混じるようになったため，泌尿器科から外科紹介となった．注腸造影で膀胱とS状結腸内に存在する膀胱内留置バルーンカテーテルが造影されたことでカテーテルによる膀胱結腸瘻と診断された．手術は瘻孔部S状結腸部分切除と，膀胱部瘻孔の縫合閉鎖を行い，今後の管理に配慮し，腹壁正中に膀胱外瘻を作成した．術後経過良好で軽快退院した．膀胱内バルーンカテーテルの長期留置が原因で膀胱S状結腸瘻を形成した報告はまれであるが，長期の膀胱内バルーンカテーテルの留置は自験例のような合併症を起こしうることを泌尿器科医・外科医は十分認識し，カテーテルの選択・間欠的導尿なども考慮すべきであると思われた．

503: Foley balloons & ruptured membranes: is there an increased risk of infection?

To investigate the rate of intrapartum infection in patients with an intracervical foley balloon (FB) stratified by ruptured membranes (ROM). We hypothesize that mechanical ripening with FB in patients with ROM increases the risk of intrapartum infection.

665: Labor induction utilizing the Foley balloon: a randomized trial comparing delayed versus immediate removal

665: Labor induction utilizing the Foley balloon: a randomized trial comparing delayed versus immediate removal

Minimal Invasive and Cost-effective Method in Reduction of Maxillofacial Fracture by Using a Foley Catheter Ballooning Technique

The purpose of this study was to introduce 2 successful cases of orbital inferior wall fracture and maxillary sinus anterior wall fracture using the Foley catheter ballooning technique. One patient is a 43-year-old man with left orbital inferior wall fracture. A window on the sinus was made for visualization, and a Foley catheter was accessed through the natural ostium. The ballooned catheter was inflated to lift the inferior orbital wall rim and stationed for 2 weeks. The window was closed using metal plates and screws. Another patient is a 64-year-old woman with right maxillary sinus anterior wall fracture, nasal fracture, and orbital blow-out fracture. A Foley catheter was accessed through the fractured maxillary sinus and reduced into place and fixed with absorbable plates screws. The technique of stabilization of reduced maxillofacial fractures using a Foley balloon catheter with restorable plates and titanium plates showed stable results. This technique is relatively easy to undergo with minimal or no complications because of reduced operation time. Also, it is cost-effective compared with other materials providing similar results and heightens patient satisfaction.

SU‐E‐T‐689: Effects of Coordinate System Orientation On ICRU Bladder Point Dose

Purpose: To quantify the displacement and dosimetric errors on position of the ICRU bladder point due to coordinate system orientation in gynecological HDR procedures. Methods: Eight patients (23 treatment fractions) receiving HDR brachytherapy for gynecological malignancies were evaluated. Bladder points were placed for each of two coordinate systems (ICRU and applicator) for each patient fraction. The ICRU coordinate system refers to true anatomical orientations (e.g., ant/post) while the applicator coordinate system is transformed (translated and rotated) based on the location and orientation treatment applicator and is used to define prescription points and optimize planned dose distributions. In both cases, the ICRU bladder point definition was used to place the point (most posterior point of foley balloon on lateral image and center of foley balloon on AP image) with differences resulting from definition of coordinate system orientation. The displacement in three dimensions and point dose differences were calculated for each patient fraction. Results: Point displacement of the applicator coordinate system point (Bappl) relative to the ICRU point (BICRU) was 6.3 ± 0.7 mm (mean ± std err) with a range of 1.5 to 12.6 mm, a statistically significant Result. Dosimetrically, dose to Bappl was 7.3 ± 1.6% (mean ± std err) of the prescribed dose higher than BICRU with a range of −7.9 to 24.7%, a statistically and clinically significant Result. This results in an overestimation of bladder dose when using the applicator coordinate system and using ICRU point dose criteria for plan evaluation. Conclusion: Failure to use a true anatomical coordinate system can lead to statistically and clinically significant dosimetric errors in dose to the defined bladder point. Use of the applicator coordinate system to define the bladder point can potentially cause compromises in plan quality in attempting to meet normal tissue dose tolerances evaluated with incorrectly reported doses.

A Comparative Study to Evaluate a Simple Method for the Management of Postoperative Bleeding Following Palatoplasty

Bleeding, is one of the most common postoperative complications after palatoplasty in patients with cleft palate. The purpose of this article is to present our experience using a Foley catheter balloon for perioperative palatoplasty bleeding management. A retrospective data analysis was performed for all cases of palatoplasty performed by the author from 1999 to 2012 that experienced postoperative hemorrhage. These patients were managed by utilizing posterior nasal compression with a Foley catheter balloon for the period 2006 to 2012. We have compared two methods (we use before 2006 the reoperative method) with regards to the later development of palatal fistulae and cases with reoperative hemostasis. The study found no statistically significant differences between the conventional and proposed method in relation to the development of palatal fistulae (P=0.7). These findings suggest that nasal packing using a Foley balloon is a safe and effective method for postoperative bleeding control after palatoplasty in patients with cleft palate.

A novel model approach for esophageal burns in rats

Corrosive esophageal injury causes serious clinical problems. We aimed to create a new experimental esophageal burn model using a single catheter without a surgical procedure. We conducted the study with two groups of 12 male rats that fasted for 12h before application. A modified Foley balloon catheter was inserted into the esophageal lumen. The control group was given 0.9% sodium chloride, while the experimental group was given 37.5% sodium hydroxide with the other part of the catheter. After 60s, esophagus was washed with distilled water. The killed rats were examined using histopathological methods after 28days. In comparison with the histopathological changes experienced by the study groups, the control groups were observed to have no pathological changes. Basal cell degeneration, dermal edema, and a slight increase in the keratin layer and collagen density of submucosa due to stenosis were all observed in the group subjected to esophageal corrosion. A new burn model can thus, we believe, be created without the involvement of invasive laparoscopic surgery and general anesthesia. The burn in our experiment was formed in both the distal and proximal esophagus, as in other models; it can also be formed optionally in the entire esophagus.

Catheter-Controlled Dilatation of Suprapubic Tract: A Novel Technique for Antegrade Access to Bladder

Introduction and Objective: Suprapubic catheterization (SPC) provides bladder drainage when urethral access is either not possible or not advisable.1 Once the SPC tract gets matured, access to the bladder for catheter change or any intervention becomes easier. However, when the tract is not yet mature and we need an antegrade access to bladder for urgent intervention like clot evacuation and/or change of malfunctioning catheter, there is always a risk of tract loss. To overcome this complexity, we have developed a novel technique called catheter-controlled dilatation (CCD) of suprapubic tract for antegrade bladder access using the same, but recently made, suprapubic tract. Running time of the video is 4 minutes 55 seconds. Materials and Methods: A total of five cases that underwent SPC within last 48 hours needed to have second intervention on emergency basis, and there was no scope for urethral access. Initial two cases required clot evacuation, while in later three, the same technique was employed for change of blocked catheter. After ensuring that preplaced Foley catheter balloon is filled with 10–15 mL of water, a transfixation suture is taken through its drainage channel and tied to occlude the balloon channel. The catheter is cut 1 cm above tied suture. Now, slide the Alken metallic dilator of suitable size over the catheter slowly till one gets the feel of Foley balloon. Dilate the tract by passing serial Alken dilators in a telescoping fashion. After dilating to maximum, pass the Amplatz sheath of corresponding size and remove all the Alken dilators. Cut the Foley catheter below the transfixed suture to deflate the balloon and remove the catheter to get an access to bladder through the Amplatz sheath for any intervention. Discussion: CCD is a useful technique with many advantages: (1) it is simple and does not require any additional expertise; (2) the technique is safe, and there is no risk of injury to posterior bladder wall due to inadvertent over-advancement of dilators, as the Foley balloon serves as protective cushion ahead of dilator tip while dilating the tract; (3) urinary bladder remains distended throughout procedure, as catheter remain occluded, this further protects from injury; (4) no fluoroscopy or ultrasonography is required; (5) no additional cost of consumable is added; (6) a wide direct access to the bladder can be obtained that is particularly useful in evacuating blood clots; (7) the technique is useful not only for immature suprapubic tract but also in stabilized tract to achieve above advantages; (8) it obviates need of transurethral cystoscopic visualization during tract dilation. Hence, it is useful when urethra is pathological (traumatized, stricture) or smaller-size cystoscopes are not available for pediatric cases. Results and Conclusions: Till date, we have successfully used this technique in five patients. The described technique of CCD is useful in retaining and dilating the previously made immature suprapubic tract without adding any complication or cost. All authors have made a significant contribution to the findings and methods in the article. All authors have read and approved the final draft. The authors have no direct or indirect financial or commercial incentive associated with publishing the article. The work has not already been published and has not been submitted simultaneously to any other journal. There is no conflict of interest. Runtime of video: 5 mins

Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations

INTRODUCTIONEndonasal procedures may be necessary during management of craniofacial trauma. When a skull base fracture is present, these procedures carry a high risk of violating the cranial vault and causing brain injury or central nervous system infection. PRESENTATION OF CASEA 52-year-old bicyclist was hit by an automobile at high speed. He sustained extensive maxillofacial fractures, including frontal and sphenoid sinus fractures (Fig. 1). He presented to the emergency room with brisk nasopharyngeal hemorrhage, and was intubated for airway protection. He underwent emergent stabilization of his nasal epistaxis by placement of a Foley catheter in his left nare and tamponade with the Foley balloon. A six-vessel angiogram showed no evidence of arterial dissection or laceration. Imaging revealed inadvertent insertion of the Foley catheter and deployment of the balloon in the frontal lobe (Fig. 2). The balloon was subsequently deflated and the Foley catheter removed. The patient underwent bifrontal craniotomy for dural repair of CSF leak. He also had placement of a ventriculoperitoneal shunt for development of post-traumatic hydrocephalus. Although the hospital course was a prolonged one, he did make a good neurological recovery. DISCUSSIONThe authors review the literature involving violation of the intracranial compartment with medical devices in the settings of craniofacial trauma. CONCLUSIONCaution should be exercised while performing any endonasal procedure in the settings of trauma where disruption of the anterior cranial base is possible.

An audit of suprapubic catheter insertion performed by a urological nurse specialist

Aims:To introduce the concept that a urological Nurse Specialist can perform Suprapubic Catheter (SPC) insertions independently without significant complications, if systematic training is given.Settings and Design:Retrospective study.Materials and Methods:A retrospective audit of Suprapubic Catheter insertions performed by a Urological Nurse Specialist was conducted between April 2009 and April 2011.Results:Of the total 53 patients, in 49 (92.45%) the procedure was successful. Out of the remaining four, two (3.77%) were done by a urologist. One patient's (1.89 %) SPC did not drain after placement and ultrasonography reported that the Foley balloon was lying within the abdominal wall. The other patient's SPC drained well for a month and failed to drain after the first scheduled change in a month. Since the ultrasonography showed the Foley balloon to be anterior to the distended bladder, an exploration was performed and this revealed that the SPC tract had gone through a fold of peritoneum before reaching the bladder. None had bowel injury.Conclusions:If systematic training is given, a urological Nurse Specialist can perform SPC insertions independently without significant complications.

Unusual Intravesical Foreign Bodies and their Management

Objective: The objective of the study was to evaluate the difficulties in diagnosis and management of various intravesical foreign bodies. Material and Methods: Retrospective review of patients with unusual intravesical foreign bodies presented at department of urology, from January 1992 to August 2011.Their record were reviewed for age and sex, clinical presentation, investigations, and treatment offered. All patients underwent evaluation including history, physical examination, ancillary testing as indicated and subjective symptom appraisal. Results: Age of the 25 patients (male female ratio, 1.7:1) in study group varied from 1 to 65 years (mean age, 34.2 years). Nineteen patients (76%) had iatrogenic foreign bodies including retained corrugated rubber sheet in 1, a piece of a Foley balloon catheter in 7, cu- T wrongly put in urethra in 1 patient, cut end of Foley’s catheter in 3, fractured segment of Foley’s catheter in 1 patient, thread pieces in 1, Malecot rubber piece in 1and DJ stent in 4 patients. All of these patients had undergone some surgical intervention or urinary tract manipulation at peripheral hospitals and presented at variable intervals after the primary intervention. Four patients (16%) had migratory foreign body and 2 (8%) had self inserted foreign body. The most common presenting symptoms were urinary frequency, and dysuria. Endoscopic retrieval was possible in 11 (44.0%) patients, percutaneous cystolithalopaxy with removal of foreign body was possible in 7 (28%) and the remaining 7 (28%) underwent open cystostomy. None of the patients had any postoperative complications Conclusion: Intravesical foreign bodies should be included in the differential diagnosis of patients presenting with chronic/recurrent lower urinary tract symptoms after previous history of pelvic surgery, instrumentation or IUCD insertion. Radiological evaluation is necessary to determine the exact size, number, and nature of foreign bodies and associated complications like stones. Most intra vesical foreign bodies can be retrieved with endoscopic and minimally invasive techniques . Keywords: Intravesical Foreign bodies, Foley’s Catheter Stem,DJ Stent, Rubber sheet, Metallic Coil Diagnosis, Management, Endoscopic Removal , Missed IUCD. Read more →

We need to know the treatment urethral injuries

Atom A Ter–Grigorian wrote an interesting review about urogenital disorders after pelvic ring injuries. This paper gives a good overview about many aspects of this problem. Though it is not extremely frequent [1], every urologist should have detailled knowledge about the treatment for all these cases. The damage of the pelvic organs is often associated with the disturbance of integrity of the pelvic ring [2]. The most important risk factor of urogenital injuries is the rupture of the symphyseal joint [3, 4]. Much more frequent than injuries of the bladder are these of the urethra. EAU guidelines on urethral traumas should be followed [5]. Management of urethral injuries remains controversial due to the variety of injury patterns, associated injuries and treatment options. Though we know this fact, most urologists have little experience with these injuries and there is a lack of randomized prospective trials. The overview of the article from Ter–Grigorian can help to find a structure in the management of that difficult varietry of treatments. Injuries of the anterior urethra are mostely caused by blunt or penetrating trauma [6], placement of penile constriction bands, and iatrogenic injuries from instrumentation. Injuries to the posterior urethra occur with pelvic fractures, mostly as a result of motor vehicle accidents [7]. Injuries vary from simple stretching (25%) to partial rupture (25%) to complete disruption (50%) [7]. Urethral injuries in women are rare. Urethral injuries in children are similar to those in adults, although injuries to the prostate and bladder neck may be more common [6, 7]. To find the diagnosis of acute urethral trauma the history always should be kept in mind. A pelvic fracture or any external penile or perineal trauma can suggest urethral trauma [8]. A high–riding prostate at digital rectal examination is an unreliable finding, but is nevertheless important to perform to exclude a concomitant rectal injury. In the absence of blood at the meatus or penile haematoma, urethral injury is very unlikely and can be excluded by catheterization. However, blood at the meatus is associated with urethral injury and urethral instrumentation should be avoided until the urethra is imaged [5]. In an unstable patient, it may be necessary to attempt to pass a urethral catheter. If there is any difficulty, a suprapubic catheter should be inserted under ultrasound guidance and a retrograde urethrogram performed later. In cases of successful urethral catheterization, the correct placement of the Foley balloon catheter inside the bladder must be checked radiographically or with ultrasound once the patient has been stabilized. In penetrating injuries, the type of weapon used, including the calibre of the bullet, helps to assess potential tissue damage. In a conscious patient, a thorough voiding history should be obtained to establish the time of last urination, the force of the urinary stream, whether urination is painful and whether haematuria is present [5]. Anyway, in most cases the most secure way is a dynamic retrograde urethrography for evaluating urethral injury [9]. This important diagnostic should always be used if possible; it is still the gold standard for this severe problem [5].

A phantom study on bladder and rectum dose measurements in brachytherapy of cervix cancer using FBX aqueous chemical dosimeter

The ferrous sulphate-benzoic acid-xylenol orange (FBX) chemical dosimeter, due to its aqueous form can measure average volume doses and hence may overcome the limitations of point dosimetry. The present study was undertaken to validate the use of FBX dosimeter for rectum and bladder dose measurement during intracavitary brachytherapy (ICBT) and transperineal interstitial brachytherapy (TIB). We filled cylindrical polypropylene tubes (PT) and Foley balloons (FB) with FBX solution and used them as substitutes for rectum and bladder dose measurements respectively. A water phantom was fabricated with provision to place the Fletcher-type ICBT and MUPIT template applicators, and FBX filled PT and FB within the phantom. The phantom was then CT scanned for treatment planning and subsequent irradiation. Our results show that the average difference between DVH derived dose value and FBX measured dose is 3.5% (PT) and 13.7% (FB) for ICBT, and 9% (PT) and 9.9% (FB) for TIB. We believe that the FBX system should be able to provide accuracy and precision sufficient for routine quality assurance purposes. The advantage of the FBX system is its water equivalent composition, average volume dose measuring capability, and energy and temperature independent response as compared to TLD or semiconductor dosimeters. However, detailed studies will be needed with regards to its safety before actual in-vivo dose measurements are possible with the FBX dosimeter.

SU-E-T-425: Impact of Model Based Dose Calculation Algorithm for Ir-192 Intracavitary Brachytherapy with Shielded Applicator.

To determine the impact of a grid based Boltzmann solver (GBBS) on a cohort of cervical cancer patients treated with Ir-192 intracavitary brachytherapy with shielded applicators. Retrospective plans were generated using BrachyVision v8.8 (TPS) with GBBS Acuros v1.3.1. The study includes 24 patients that had CT planning images acquired with CT/MR compatible applicators. Using the TPS applicator library, shielded colpostats and tandem (#AL13122005) were virtually positioned to replace the applicators seen on CT. Dwell weights were based on TG43 delivering 6 Gy to point A. Four GBBS calculations were performed to assess differences from the standard of practice TG43. The different GBBS calculations were: 1) no applicator modeled, body= 1 g/cc muscle, 2) applicator modeled, body=1g/cc muscle, 3) applicator modeled, CT-to-material mapping with contrast (vaginal packing, rectal, Foley balloon) = 1g/cc muscle, and 4) applicator model, CT-to-material mapping without material overrides. The multiple GBBS calculations allow differences from TG43 to be attributed to factors representing the modeling of source and patient boundaries (scatter conditions), tissue heterogeneities, and applicators. Differences between GBBS4 and TG43 at clinical dosimetric points were as follows: [mean ± standard (min, max)], Point A: - 2.5% ± 0.5% (-3.8%, -1.2%), Point B: -1.5% ± 1.0% (-3.2%, 1.1%), ICRU rectum: -8.4% ± 2.5% (-14.0%, -4.1%), D2cc rectum: -6.2% ± 2.6% (- 11.9%, -0.8%), ICRU bladder: -7.2% ± 3.6% (-15.7%, -2.1%); D2cc bladder: -3.4% ± 1.8% (-7.2%, -1.1%). Bar plots comparing the modeling factors previously listed show that applicator modeling is the largest contributor to differences from TG43. Clinically significant dose differences (>5%) relative to TG43 exist when using a model-based dose calculation algorithm such as the GBBS with shielded applicators. Differences were largely due to applicator modeling, not tissue heterogeneities, source modeling, or patient boundary modeling.

Management of a cervical heterotopic pregnancy presenting with first-trimester bleeding: case report and review of the literature

To report a rare case of a cervical heterotopic pregnancy resulting from intrauterine insemination (IUI) that presented with first-trimester bleeding. Case report and literature review. Large university-affiliated infertility practice. A 40-year-old gravida 2 para 1 Asian woman at 7-3/7 weeks gestational age following clomiphene citrate/IUI for the treatment of secondary infertility presented with heavy vaginal bleeding for several days. Transvaginal ultrasound on admission revealed a single live intrauterine pregnancy and a cervical gestational sac containing a nonviable embryo. The patient continued to have vaginal bleeding and 2 days later underwent removal of the cervical ectopic pregnancy tissue with ring forceps, as well as an ultrasound-guided intracervical Foley balloon and cerclage placement. The bleeding subsided, and 48 hours later the Foley and cerclage were removed. Pregnancy outcome. The remainder of the pregnancy was uncomplicated and the patient had a full-term cesarean delivery for footling breech of a healthy male infant. Cervical heterotopic pregnancy is a very rare event that almost universally results from infertility treatment. We present a case where we were able to remove the cervical ectopic and tamponade the bleeding, thus preserving the intrauterine pregnancy for this subfertile couple, and we review the existing literature.

Cervical dilation as a predictor of pregnancy outcome following emergency cerclage

Objective: To determine whether cervical dilation at the time of physical examination indicated cerclage placement can predicts latency and gestational age at delivery. Methods: A retrospective cohort study of all women who underwent physical examination indicated cerclage placement from 1996 to 2011 at Duke University Hospital (DUH) was performed. Physical examination indicated cerclage was defined as cerclage placement after 16 weeks in women with a cervical length of less than 2.5 cm and/or cervical dilation greater than or equal to 1 cm at time of procedure. Subjects were divided into two groups depending on cervical dilation at time of procedure (≥2 cm, <2 cm) for comparison. A multivariate linear regression model for the outcome gestational age of delivery was constructed, controlling for confounding variables. Results: A total of 110 women with complete data were available for analysis. Median gestational age at cerclage placement was similar between the two groups (20.3 vs. 20.3 weeks, p = 0.8). Women with cervical dilatation ≥2 cm dilation delivered at an earlier median gestational age than women with cervical dilation <2 cm (27.0 vs. 35.6 weeks, p < 0.001). Cervical dilation at the time of cerclage placement independently predicted gestational age at delivery while controlling for use of intracervical Foley balloon catheter for membrane reduction, cerclage suture type, history of prior preterm birth, race, insurance status, and tobacco use. Conclusions: Women who receive a rescue cerclage are more likely to deliver at an earlier gestational age when cervical dilation is ≥2 cm at the time of procedure.