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

Abstract

Exam-indicated cerclage appears to prolong gestation compared to expectant management.

Emergency Cerclage: Outcomes, Patient Selection, and Operative Considerations

“…Inclusion criteria for the studies reported in this analysis included women with a gestational age of 14 to 27 weeks (mean of 21.7 wk in cerclage group and 22.8 wk in expectant group) and cervical dilation of 1 to 5 cm (mean of 3.3 cm in cerclage group and 3.5 cm in expectant group). [4][5][6][7][8][9][10][11][12][13] The authors found improved neonatal survival [71% vs. 43%; relative risk (RR) 1.66; 95% confidence interval (CI), 1.19-2.28), fewer deliveries before 34 weeks gestation (50% vs. 83%; RR 0.55; 95% CI, 0.38-0.80), and a nonsignificant trend toward fewer deliveries before 24 weeks gestation (23% vs. 33%; RR 0.47; 95% CI, 0.14-1.53) among women who underwent emergency cerclage compared with women managed expectantly. Mean gestational age at delivery was 30.6 weeks in the cerclage group compared with 25.2 weeks in the expectantly managed group (RR 4.62; 95% CI, 3.89-5.36) with mean time to delivery of 56.7 and 18.8 days, respectively.…”

“…21,26 In a retrospective cohort study of 52 women, the mean white blood cell (WBC) count was higher among women who were expectantly managed when compared with those who underwent physical examination-indicated cerclage (14.7 vs. 9.76 k/mL), suggesting provider avoidance of cerclage placement in cases of leukocytosis. 6 Although a strict cut-off for WBC has not yet been identified in prospective studies, leukocytosis in this sitting should give the obstetrician pause and increase suspicion for a subclinical infection. The use of amniocentesis and amniotic markers of infection for patient selection will be reviewed separately.…”

Cerclagem de emergência: resultados gestacionais, neonatais e fatores prognósticos

“…Os (32) encontraram resultados semelhantes, 28 semanas e 23 semanas, respectivamente. Outros autores (28,(34)(35)(36) descrevem idade gestacional do parto mais elevada, variando entre 29 e 34,8 semanas no grupo cerclagem e 24 e 27,7 semanas no grupo controle. O período de latência médio obtido foi 48,63 dias no grupo cerclagem e 16 dias no grupo repouso.…”

“…(29,30) . Destes, apenas um foi randomizado (29) , e houve número reduzido de casos ( (30,32,34,36) .…”

“…Quanto aos antecedentes obstétricos, não houve diferença entre os grupos quanto à nuliparidade e antecedente de aborto ou de parto prematuro. Outros autores também não identificaram diferença entre os grupos quanto aos antecedentes obstétricos (28,32,34) .…”