Emergency cerclage in twins during mid gestation may have favorable outcomes: Results of a retrospective cohort

Cilingir, Isil Uzun; Sayın, Cenk; Sütçü, Havva; İnan, Cihan; Erzincan, Selen Gürsoy; Yener, Cem; Varol, Füsun

doi:10.1016/j.jogoh.2018.08.010

Cited by 16 publications

(12 citation statements)

References 6 publications

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“…After analyzing all the above data and in accordance with the updated literature [29][30][31][32][33][34][35][36][37], we conclude that the use of our TSEC technique could extend the latency period and, accordingly, result in lower prematurity rates. Its effect was especially beneficial in patients with poor prognoses (prolapsed membranes, cervical dilatation, conization patients), for whom outcomes in most studies have been unsatisfactory.…”

Section: Discussionsupporting

confidence: 72%

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Gómez-Castellano

Sabonet

González-Mesa

et al. 2022

IJERPH

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(1) Background: The objective of our prospective observational study was to evaluate a new technique for emergency cerclage, which was performed on a cohort of patients with cervical incompetence in the second trimester. (2) Methods: 26 pregnant women presented at 15 to 24 weeks of gestation with cervical dilatation and bursa prolapse. A new emergency cerclage was performed using a technique consisting of the first cerclage in a tobacco bag and a second occlusive cerclage located inferiorly to the first. The technique is concluded with the performance of a cervical cleisis when vaginal bag prolapse is present, and this overall procedure is called the three-step procedure for emergency cerclage (TSEC). (3) Results: To assess its effectiveness, we measured the latency from procedure to delivery, pregnancy duration, infant birth weight, and rate of premature amniorrhexis. The mean latency from procedure to delivery was 14 weeks + 6 days, the mean weight of newborns was 2550 g and the mean gestational age at delivery was 35 weeks. The neonatal survival rate was 95.8%. The rate of premature amniorrhexis (<34 weeks gestational age) was 8.3% (two cases) with successful perinatal outcomes. There were significant differences (p < 0.05) between groups. A multivariate regression model showed that the best variables for predicting the latency to delivery were the cervical dilatation at diagnosis, use of the three-step cerclage, cervical length after the procedure, and gestational age at diagnosis. (4) Conclusions: The excellent results obtained with the TSEC procedure in terms of the latency from the procedure to delivery, gestational age at delivery, birth weight, and having few reported complications highlight the importance of collecting new data on this promising novel procedure.

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Section: Discussionsupporting

confidence: 72%

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Gómez-Castellano

Sabonet

González-Mesa

et al. 2022

IJERPH

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“…Although 78.9%(15/19) of women in the control group were delivered within 1 week from admission and only one extreme prematurity infant lived (Table 3). In contrast, previous case series showed unreliable results on the benefits of cerclage 19,20 . One included only four twin pregnancies with dilated cervix (4 cm) and prolapsed membranes, and found that all of them developed late abortions after cerclage.…”

Section: Discussionmentioning

confidence: 89%

“…In contrast, previous case series showed unreliable results on the benefits of cerclage. 19,20 One included only four twin pregnancies with dilated cervix (4 cm) and prolapsed membranes, and found that all of them developed late abortions after cerclage. The other investigated nine twin pregnancies, and showed that only one patient had a live infant to take home.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes

Zeng

Pei

et al. 2021

Intl J Gynecology & Obste

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Objective To determine the effect of mid‐trimester emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes, and to identify risk factors predicting spontaneous preterm birth (sPTB) before 28 weeks, after cerclage. Methods Retrospective analysis of twin gestations with cervical dilation and prolapsed membranes treated with emergency cerclage or expectant management (2015–2020). The primary outcomes were the rate of sPTB before 28 weeks and the gestational latency. Multiple logistic regression analysis was used to determine the factors associated with sPTB before 28 weeks, after cerclage. Results Ninety‐seven women were included, cerclage (n = 58) or no cerclage (n = 39). Cerclage placement was associated with significantly lower incidence of sPTB before 28 weeks of pregnancy (34.5% vs 82.1%) and prolongation of the gestational latency (46.71 ± 27.52 vs 10.95 ± 11.71 days). Positive cervical culture (odds ratio [OR] 10.69, 95% confidence interval [CI] 1.82–62.95), pregnancy duration at diagnosis less than 22 weeks (OR 9.42; 95% CI 1.69–52.69) and cervical dilation at least 4 cm (OR 7.92; 95% CI 1.40–44.71) were found to be independent risk factors for sPTB before 28 weeks, after cerclage. Conclusion Emergency cerclage in women with twin pregnancies with cervical dilation and prolapsed membranes was associated with an overall 40% decrease in sPTB before 28 weeks and a prolongation of latency by 5 weeks. The strongest predictor of sPTB before 28 weeks after cerclage was a positive cervical culture.

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“…In twin pregnancies with cervical incompetence, this procedure might be taken into consideration only as a rescue treatment [84]. Although the randomized controlled trials are unavailable, Cilingir et al suggest that this procedure in patients with twin pregnancies and cervical shortening less than 15 mm should be performed [85]. The emergency cervical cerclage can be an alternative of treatment only for selected women with twin pregnancies with advanced cervical dilatation and exposed fetal membranes.…”

Section: Risk Factors Of the Emergency Suture Failurementioning

confidence: 99%

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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Emergency cerclage in twins during mid gestation may have favorable outcomes: Results of a retrospective cohort

Cited by 16 publications

References 6 publications

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

A Three-Step Procedure for Emergency Cerclage: Gestational and Neonatal Outcomes

Pregnancy outcomes and factors affecting the clinical effects of emergency cerclage in twin pregnancies with cervical dilation and prolapsed membranes

Emergency Cervical Cerclage

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