Amniocentesis Prior to Physical Exam–Indicated Cerclage in Women with Midtrimester Cervical Dilation: Results from the Expectant Management Compared to Physical Exam–indicated Cerclage International Cohort Study

Abstract

We evaluated whether the performance of an amniocentesis in women with a dilated cervix presenting at less than 26 weeks and subsequently managed by a physical exam-indicated cerclage increases the risk of spontaneous preterm birth (PTB) less than 28 weeks. Women between 15 (0)/ (7) to 25 (6)/ (7) weeks' gestation with a dilated cervix (1 to 4 cm) were identified. Multiple exclusion criteria were designated. The primary outcome was PTB less than 28 weeks. One hundred twenty-two women with a dilated cervix between 15 and 25 (6)/ (7) weeks gestational age were identified. Twenty-four (20%) of these had an amniocentesis performed. The unadjusted rate of PTB < 28 weeks differed between women who underwent amniocentesis compared with those who did not (58% versus 34%, respectively, P = 0.02), but after multivariate regression analysis, the performance of an amniocentesis was not an independent contributor to PTB < 28 weeks ( P = 0.90). The performance of an amniocentesis prior to cerclage did not independently contribute to PTB less than 28 weeks.

Exam‐indicated cerclage in patients with fetal membranes at or beyond external os: A retrospective evaluation

“…Two of these patients opted for termination of pregnancy, in view of the consequent anhydramnios, whereas miscarriage occurred in the other two cases. The overall miscarriage rate in Group I was 13% (5/37) at a median gestational age of 21 weeks 21–23 …”

“…The demographic and clinical characteristics of the two groups are listed in Table 1. The median gestational age of Group I at the time of the operation was 22 weeks 17–27 . Accidental amniorrhexis occurred during operation in one case.…”

Emergency Cerclage: Outcomes, Patient Selection, and Operative Considerations

“…Studies demonstrating better outcomes when amniocentesis was performed were typically not randomized and thus susceptible to selection bias, as providers generally decided which patients should undergo the procedure. 29,30 Although randomized trials are lacking, amniocentesis should be considered before emergency cerclage when the presence or absence of intra-amniotic infection is not clinically certain, as there is good evidence that these women are not likely to benefit from the procedure. 31…”

Non-invasive emergent cerclage using a plastic sling: case series

“…The most feared complication of an emergency cervical cerclage is the rupture of membranes during the procedure, especially when the cervix is wide open and the membranes are protruding. To decrease that complication, some methods to reduce the prolapsed membranes have been used: filling the bladder with 0.45% saline solution through a Foley catheter,10 performing an amniocentesis to decrease intra-amniotic pressure and subsequent reduction of the prolapsed membranes11 as well as the use of balloons to push the membranes back into the uterus before the placement of a McDonalds suture 12–14. In all the previous techniques, the needle is still used and the introduction of such a sharp instrument is a very risky step 6 12.…”