Emergency Cerclage: Improvement of Outcomes by Standardization of Management

Rius, Mariona; Cobo, Teresa; García-Posadas, R; Hernández, Sandra; Teixidó, Irene; Barrau, Enrique; Abad, Carmen; Palacio, Montse

doi:10.1159/000433465

Cited by 8 publications

(6 citation statements)

References 28 publications

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Section: Discussionsupporting

confidence: 88%

“…We found our median GA (27.1 weeks) and latency (43 days) to delivery to be consistent, although at the lower limit, with recent literature in which the mean GA at delivery ranges from 27-32 weeks with a mean latency to delivery of 42-92 days. 15,[18][19][20][23][24][25] According to some authors, a lower GA and latency to delivery could be influenced by the greater number of cases with advanced cervical dilation at presentation. Park et al 20 reported that the size of visible membranes was independently associated with preterm delivery before 28 weeks (OR 1.553; 95% CI, 1.148-2.101).…”

Section: Ta B L E 2 Pregnancy Outcomesmentioning

confidence: 99%

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Latency to delivery in physical examination‐indicated cerclage in twins is similar to that in singleton pregnancies

Ponce

Benitez

Baños

et al. 2021

Intl J Gynecology & Obste

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Objective To compare latency to delivery and perinatal outcomes between twin and singleton pregnancies undergoing physical examination‐indicated cerclage. Methods Retrospective observational study (2007–2017) of women who underwent physical examination‐indicated cerclage at the Hospital Clinic of Barcelona. Primary outcomes were latency from cerclage to delivery and gestational age at delivery. Secondary outcomes included: neonatal morbidity and mortality, preterm prelabor rupture of membranes, clinical chorioamnionitis and cerclage displacement. Wilcoxon‐test and χ2 test were used to compare continuous and categorical variables. Results Sixty women were included (17 twins and 43 singletons). There were no differences in gestational age at cerclage or presence of bulging membranes between groups. Median (25th;75th percentile) gestational age at delivery was 27.1 (24.5;32.3) weeks in the twin group and 27.6 (25.3;35.3) weeks in the singleton group (P = 0.594). There were no statistically significant differences in latency from cervical cerclage to delivery between the two groups (43 days [21;64] vs. 29 days [16;76], respectively; P = 0.938). There were no differences in neonatal mortality (2/26 [7.7%] vs. 1/33 [3.1%]; P = 0.578) or in composite neonatal morbidity (14 [53.9%] vs. 14 [42.4%]; P = 0.283) between groups, respectively. Conclusion These results suggest that physical examination‐indicated cerclage placement in twins could prolong latency to delivery similarly to singleton pregnancies.

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Section: Discussionsupporting

confidence: 88%

Section: Ta B L E 2 Pregnancy Outcomesmentioning

confidence: 99%

Latency to delivery in physical examination‐indicated cerclage in twins is similar to that in singleton pregnancies

Ponce

Benitez

Baños

et al. 2021

Intl J Gynecology & Obste

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“…The Spanish authors analyzed the results of 39 patients who underwent emergency cervical cerclage. The average prolongation of pregnancy in these patients was 49.1 days, with a mean delivery time of 28.6 weeks and neonatal survival of 82.4% [67]. Slightly less favorable results were obtained in the analysis of 23 patients described by Caruso et al [68].…”

Section: Rescue Suture Effectivenessmentioning

confidence: 79%

Emergency Cervical Cerclage

Wierzchowska-Opoka

Kimber-Trojnar

Leszczyńska‐Gorzelak

2021

JCM

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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.

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“…The Royal College of Obstetricians and Gynaecologists (RCOG) in the UK and the Queensland Clinical Guideline [5] suggest individualized decision-making. RCOG considers the high morbidity and mortality rates of extremely preterm neonates, while [6][7][8][9]. In 2015, a prospective study by Ciancimino et al also confirmed the positive results of emergency cervical cerclage with 12 patients receiving ECC at 17-26 weeks of gestation, resulting in an average prolongation of pregnancy by 89.9 days and a neonatal survival rate of 83.3% [10].…”

Section: Discussionmentioning

confidence: 93%

Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24–28 weeks of gestation

Yi,

Zhang,

Yang

et al. 2024

Arch Gynecol Obstet

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Background Cervical cerclage is the only effective treatment for cervical insufficiency, effectively preventing late miscarriage and preterm birth. The effectiveness and safety of emergency cervical cerclage (ECC) as an emergency treatment when the cervix is already dilated or when there is protrusion of the fetal membranes into the vagina remain controversial, especially in pregnancies at 24–28 weeks when the fetus is viable. There is still no consensus on whether emergency cervical cerclage should be performed in such cases. Purpose To investigate the effectiveness and safety of emergency cervical cerclage in singleton pregnant women at 24–28 weeks of gestation. Methods This study employed a single-center prospective cohort design, enrolling singleton pregnant women at 24–28 weeks of gestation with ultrasound or physical examination indicating cervical dilation or even membrane protrusion. Emergency cervical cerclage was compared with conservative treatment. The primary endpoints included a comprehensive assessment of perinatal pregnancy loss, significant neonatal morbidity, and adverse neonatal outcomes. Secondary endpoints included prolonged gestational age, preterm birth, neonatal hospitalization rate, premature rupture of membranes, and intrauterine infection/chorioamnionitis. Results From June 2021 to March 2023, a total of 133 pregnant women participated in this study, with 125 completing the trial, and were allocated to either the Emergency Cervical Cerclage (ECC) group (72 cases) or the conservative treatment group (53 cases) based on informed consent from the pregnant women. The rate of adverse neonatal outcomes was 8.33% in the ECC group and 26.42% in the conservative treatment (CT) group, with a statistically significant difference (P = 0.06). There were no significant differences between the two groups in terms of perinatal pregnancy loss and significant neonatal morbidity. The conservative treatment group had a mean prolonged gestational age of 63.0 (23.0, 79.5) days, while the ECC group had 84.0 (72.5, 89.0) days, with a statistically significant difference between the two groups (P < 0.001). Compared with CT group, the ECC group showed a significantly reduced incidence of preterm birth before 28 weeks, 32 weeks, and 34 weeks, with statistical significance (P = 0.046, 0.007, 0.001), as well as a significantly decreased neonatal hospitalization rate (P = 0.013, 0.031). Additionally, ECC treatment did not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis, with no statistically significant differences (P = 0.406, 0.397). Conclusion In singleton pregnant women with cervical insufficiency at 24–28 weeks of gestation, emergency cervical cerclage can reduce adverse neonatal pregnancy outcomes, effectively prolong gestational age, decrease preterm births before 28 weeks, 32 weeks, and 34 weeks, lower neonatal hospitalization rates, and does not increase the risk of preterm premature rupture of membranes or intrauterine infection/chorioamnionitis.

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Emergency Cerclage: Improvement of Outcomes by Standardization of Management

Cited by 8 publications

References 28 publications

Latency to delivery in physical examination‐indicated cerclage in twins is similar to that in singleton pregnancies

Latency to delivery in physical examination‐indicated cerclage in twins is similar to that in singleton pregnancies

Emergency Cervical Cerclage

Analysis of perinatal outcomes for emergency cervical cerclage in singleton pregnancies at 24–28 weeks of gestation

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