Does amnioreduction increase success of emergency cervical cerclage in cases with advanced cervical dilatation and protruding membranes?

Çakıroğlu, Yiğit; Döğer, Emek; Köpük, Şuler Yıldırım; Günlemez, Ayla; Oğuz, Demet; Çalışkan, Eray

doi:10.12891/ceog2120.2016

Cited by 6 publications

(5 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Amniocentesis is also a risk factor for chorioamnionitis and stimulus of uterine contractions. Cakiroglu et al [24] reported comparable results between groups with or without amnioreduction before rescue cerclage. Other than intraamniotic bag pressure, the effectiveness of anesthesia can also influence the risk of rupture of membranes.…”

Section: Discussionmentioning

confidence: 93%

Rescue Cervical Cerclage for Protruding Amniotic Sac: A Retrospective Analysis of Clinical Efficacy

Hsu¹,

Hsu²,

Wang³

et al. 2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

Background: Cervical insufficiency, or cervical incompetence, describes the condition in which the cervix dilates without painful uterine contractions in the second trimester of pregnancy. It often leads to loss of pregnancy or preterm delivery. Recommendations for the prophylactic placement of cervical sutures are well established, however rescue cervical cerclage for a prolapsing amniotic bag is more controversial due to higher technical demands, higher risk of iatrogenic rupture of membranes, and questionable long-term neonatal prognosis. This study aimed to answer two important questions: (1) Should rescue cerclage be performed for those with an evidently protruding amniotic bag? (2) Who would benefit the most from rescue cerclage? Materials: Eighteen pregnant women with cervical incompetence with a clinically evident prolapsing amniotic bag from January 2016 to February 2020 were included. Four received conservative treatment, i.e., without cerclage, and the other 14 patients opted to receive emergency rescue cervical cerclage. Results: We classified the patients into futile (n = 7) and successful (n = 7) cerclage groups at post-operative day 21. Pregnancy and neonatal outcomes were obviously better in the success group, however no significant pre-operative predictive factors for success could be identified. The results of the women who did not receive cerclage and those with futile cerclage were comparable. Rescue cerclage was especially beneficial for those at 22 weeks to 26 weeks of gestation. Conclusions: The maternal and fetal outcomes of the patients with futile rescue cerclage were comparable to those who did not receive cerclage. Therefore, rescue cerclage for advanced cervical insufficiency could be considered, especially for those at 22 weeks to 26 weeks of gestation.

show abstract

Section: Discussionmentioning

confidence: 93%

Rescue Cervical Cerclage for Protruding Amniotic Sac: A Retrospective Analysis of Clinical Efficacy

Hsu¹,

Hsu²,

Wang³

et al. 2022

Clin. Exp. Obstet. Gynecol.

View full text Add to dashboard Cite

show abstract

“…Cakroglu et al reported no difference in pregnancy or neonatal outcomes according to amnioreduction [ 11 ]. The authors argued that amnioreduction was meaningful as a means to determine the presence of chorioamnionitis even though it did not improve the prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…Among those methods, amnioreduction facilitates the replacement of the protruding membrane by reducing the hydrostatic force. Through several studies, amnioreduction has been proven to be a feasible method [ 10 , 11 , 12 , 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Amnioreduction before Physical Examination-Indicated Cerclage on Pregnancy Outcomes: A Propensity Score Matched Study

Hong

Kim

et al. 2023

JCM

View full text Add to dashboard Cite

This study investigated the effects of amnioreduction before physical examination-indicated cerclage on pregnancy outcomes using a propensity score matching analysis. This multicenter retrospective cohort study included women who underwent cerclage operations due to painless cervical dilation in the second trimester (14–28 weeks). The primary outcome was the time from operation until delivery. Secondary outcomes included preterm birth rate and neonatal outcomes. Primary and secondary outcomes were compared between those with amnioreduction and those without amnioreduction. Of 103 women, 31 received preoperative amnioreduction (amnioreduction group) and 72 women did not (no-amnioreduction group). Since there were differences in baseline characteristics and preoperative ultrasound findings between the two groups, we matched 25 women with amnioreduction and 25 women without amnioreduction using a propensity score. In the matched cohort, the amnioreduction group showed a shorter time from operation to delivery than the group without amnioreduction and the hazard ratio of amnioreduction was 2.5 (95% confidence interval; 1.4–4.7). In addition, the preterm birth rate before 28 weeks of gestation and the neonatal composite outcome were higher in the amnioreduction group than that in the group without amnioreduction. Amnioreduction before physical examination-indicated cerclage was associated with poor pregnancy and neonatal outcomes. Therefore, careful consideration is required when performing amnioreduction before cerclage operation.

show abstract

“…Locatelli A. et al have reported 16 patients with cervical dilation (2–5 cm) and prolapse of fetal membranes, including seven cases with ECC and nine cases with ECC and amnioreduction, and found that with the comparable prolongation of pregnancy, the amnioreduction before ECC is associated with a lower rate of delivery before 32 weeks and neonatal morbidity [ 23 ]. One recent study by Cakiroglu Y. et al found that ECC yielded no different outcomes for prolongation of pregnancy and live birth rate after comparing between amnioreduction group and non-amnioreduction group [ 22 ]. Another compared study from Japan also showed similar pregnancy outcomes after ECC between eight patients with amnioreduction and nine cases without amnioreduction, even though the size of forewater detected by ultrasound was larger in amnioreduction group [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…In 1979, Robert C. Goodwin reported for the first time the application of amnioreduction before ECC to reduce the tension of the protruding amniotic sac in the vagina [21]. Since then, several studies have reported on amnioreduction prior to ECC for bulging membranes, however, the pregnancy outcomes were inconsistent due to the heterogeneity of cases [22][23][24][25][26]. To improve the success of ECC procedure and pregnancy outcomes among patients with large bulging membranes, our hospital started to adopt amnioreduction prior to ECC since December 2016.…”

Section: Introductionmentioning

confidence: 99%

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study

et al. 2022

View full text Add to dashboard Cite

The purpose of this study was to investigate the role of amnioreduction in patients who underwent emergency cervical cerclage (ECC) with bulging membranes during the second trimester. This retrospective comparative study included 46 singleton pregnant women who had cervical dilation at least 1 cm with bulging membranes beyond the external cervical os and underwent ECC at the Third Affiliated Hospital of Sun Yat-sen University between December 2016 and December 2021. Cases were categorized as amnioreduction group (n = 16) and non-amnioreduction group (n = 30) according to whether amnioreduction was performed prior to ECC. The gestational age and cervical dilation at cerclage, operative time, prolongation of pregnancy, and outcomes of pregnancy were compared between the two groups. All 46 patients underwent successful ECC excepted one case with intraoperative rupture of membrane in non-amnioreduction group. In the amnioreduction group, the cervical dilation at cerclage was larger than that in the non-amnioreduction group (4.5 ± 2.2 vs. 2.2 ± 1.2 cm, P < 0.001), and had more patients with cervical dilation ≥4 cm (50.0% vs. 10.0%, P = 0.004). However, the gestational age at cerclage, operative time, prolongation of pregnancy, gestational age at delivery were not significantly different between the two groups (22.9 ± 2.8 vs. 22.9 ± 3.2 weeks, 31.1 ± 9.2 vs. 27.9 ± 11.4 min, 21.3 ± 21.5 vs. 38.7 ± 40.2 days, 25.9 ± 4.5 vs. 28.4 ± 6.1 weeks; P > 0.05). The rates of delivery ≥28 weeks, ≥32 weeks, and live birth were 20.0% vs. 80.0%, 12.5% vs. 26.7%, 56.3% vs. 66.7% (P > 0.05) in amnioreduction group and non-amnioreduction group, respectively. In conclusion, even in cases with larger cervical dilation, the application of amnioreduction with ECC is possible to get the acceptable pregnancy outcomes. These findings suggested that amnioreduction may be a safe and feasible option to be applied before ECC, especially for those with advanced cervical dilation and bulging membranes.

show abstract

Does amnioreduction increase success of emergency cervical cerclage in cases with advanced cervical dilatation and protruding membranes?

Cited by 6 publications

References 18 publications

Rescue Cervical Cerclage for Protruding Amniotic Sac: A Retrospective Analysis of Clinical Efficacy

Rescue Cervical Cerclage for Protruding Amniotic Sac: A Retrospective Analysis of Clinical Efficacy

Effects of Amnioreduction before Physical Examination-Indicated Cerclage on Pregnancy Outcomes: A Propensity Score Matched Study

The Role of Amnioreduction in Emergency Cervical Cerclage with Bulging Membranes: A Retrospective Comparative Study

Contact Info

Product

Resources

About