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cerclage, cervix, emergency or emergent cerclage, rescue cerclage and incompetent cervix
emergency cerclage, in Saudi women who present with a
dilated cervix and bulging or ’hour-glass’ membranes in the absence of labor. To compare the perinatal outcome in Saudi women with emergency cerclage with the results published in the peer reviewed international literature.
Methods: Prospective data collection on perinatal and maternal outcomes of Saudi women who had an emergency cerclage placed by operators at the Riyadh Central Maternity Hospital in the Kingdom of Saudi Arabia from April 2005 to October 2005. For comparison of the local outcome with the published experience, a literature review was conducted with the terms ‘cerclage’, ‘cervix’, ’emergency or emergent cerclage’, ’rescue cerclage’ and ‘incompetent cervix’, using an OVID interface to access MEDLINE records. The mean values and standard deviations or range were calculated for the following outcomes of interest: gestational age and cervical dilatation at the time of emergency cerclage, gestational age at delivery, latency of pregnancy from cerclage placement to delivery, birth weight of the infant. Adverse maternal and perinatal outcomes were tabulated.
Results: In the specified time frame, 14 women underwent emergency cervical cerclage at the Riyadh Central Maternity Hospital. The average time between cerclage placement and delivery was 7 weeks and 3 days, which allowed for 12 of 14 neonates to be born at 28 weeks or later. 3 neonates had a birth weight under 1000 g. The average neonatal survival was 93%. Histological data are available for 12 placentas. 2 placentas demonstrated a histological diagnosis of chorioamnionitis, although none of the blood cultures from the neonates revealed septicemia. The PPROM rate was 14%.
The literature review from 1993 to 2005 identified 24 peer- reviewed publications, which described the perinatal outcome of 638 women who underwent emergency cerclage for the same indications as the present cohort study of Saudi women.
The average prolongation of the pregnancy was 7 weeks and 1 day. The average neonatal survival exceeded 70% (range 47.2% to 96%) and 60% of the neonates (range 26% to 80%) were born after 28 weeks gestation. Chorioamnionitis was reported in 5% to 80% of pregnancies and preterm premature rupture of the membranes complicated an average of 29% of gestations (range 1% to 58%).
Conclusion: The results of this prospective study as well as the data available in the medical literature suggest that emergency cerclage can significantly prolong pregnancy and increase the likelihood of fetal viability. These therapeutic benefits have to be considered in light of the increased risk of chorioamnionitis and associated fetal inflammatory brain insult as well as the risk of extending pregnancy from previability to severe prematurity.