OBSTETRIC MANAGEMENT OF INCOMPETENT CERVIX AND BULGING FETAL MEMBRANES

OBJECTIVE: To evaluate the effect of emergency cerclage on perinatal o utcome in patients with incompetent cervix. STUDY DESIGN: In this desc riptive retrospective study, the charts of all patients admitted from 1985 to 1999 with a diagnosis of incompetent cervix and cervical dilat ation greater than or equal to 2 cm were reviewed. Cervical dilatation at the time of cerclage placement, subsequent pregnancy duration and neonatal outcome were analyzed. Statistical analysis was performed usi ng the paired Student t test. RESULTS: During the eight-year period, 4 2 patients were admitted with a diagnosis of incompetent cervix, cervi cal dilatation greater than or equal to 2 cm, and underwent emergency cerclage. Cerclage resulted in a median (range) continuation of pregna ncy of 30 (2-102) days. In 20 of these patients the membranes were not bulging through the external cervical os, and pregnancy was extended a median of 50 (30-102) days. The remaining 22 patients presented with membranes bulging into the vagina, and emergency cervical cerclage re sulted in a median pregnancy extension of 16 (2-98) days. Parturients with bulging membranes were then analyzed according to cervical dilata tion. Cerclage success was significantly lower when attempted at a cer vical dilation greater than or equal to 4 cm. Median pregnancy duratio n was 6 (2-15) versus 21 (5-98) days in patients with cervical dilatat ion <4 cm. CONCLUSION: The results of this study support emergency cer clage in patients without bulging membranes. The data do not support t he use of emergency cervical cerclage in patients with bulging membran es and dilatation greater than or equal to 4 cm. In those patients, th e use of cerclage should be individualized.