OUTCOME OF 2ND-TRIMESTER, EMERGENCY CERVICAL CERCLAGE IN PATIENTS WITH NO HISTORY OF CERVICAL INCOMPETENCE

A retrospective, descriptive study was conducted to evaluate the outco me of second-trimester, emergency cervical cerclage in patients with n o history of cervical incompetence. Thirty-two women with singleton pr egnancies were studied. All had undergone emergency cervical McDonald cerclage at 17 to 25 weeks' gestation because of cervical dilation and effacement. The procedure was carried out after a rest period of 6 or more hours, during which none of the patients demonstrated uterine ac tivity. The mean procedure-to-delivery interval was 6.9 +/- 5.6 (media n 5.5, range 0.2 to 18) weeks. Thirteen pregnancies (41%) terminated b efore 24 weeks. The mean gestational age at delivery was 28.5 +/- 5.8 weeks for the entire group, and 32.3 +/- 4.4 (range 25 to 38) weeks fo r the 19 who achieved viability. The mean birthweight of the live infa nts was 1935 +/- 958 g (median 1670, range 905 to 3710 g). Four infant s died during the neonatal period. The total survival rate was 47%, an d the survival rate corrected for major anomalies was 48.4%. The perin atal mortality rate was significantly higher among patients with membr anes protruding through the cervix on admission, compared to those wit hout (75% vs 17%; p = .003). We concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical in competence is associated with an approximately 50% survival rate. Memb ranes protruding through the dilated cervix are a poor prognostic fact or for survival in these cases.