Emergency cerclage - Prognostic factors and complications

The performance of an emergency cerclage in patients with a dilated cervix and bulging fetal membranes in the second trimester of pregnancy implicates the prolongation of pregnancy on the one hand and risks for mother and fet us on the other hand. Due to the lack of a randomised trial this retrospect ive study analyses the data of all emergency cerclages (n = 21) performed a t the university hospital in Bonn (Germany) from 1995 to 1998. Patients rec eiving emergency cerclage were at a mean gestational age of 23 + 4 weeks of pregnancy p.m. with a mean dilated cervix of 5.5 cm. Neither operational t echnique (McDonald or Shirodkar) nor the extent of dilatation influenced th e outcome of pregnancy, in contrast with other reports. In 2 out of 21 preg nancies rupture of membranes occurred in association with operational proce dures. Only 48% of the patients had risk factors (cervical incompetence, pr egnancy losses, cervical operations) in their history. Mean prolongation of pregnancy reached 40 days, but was lower for multiple pregnancy (mean 21 d ays). 18 (86%) out of 21 pregnancies treated resulted in the birth of a sur viving child; nevertheless, fetal survival rate reached only 69% due to the more complicated course of multiple pregnancies (n = 5). Complications inc luded mainly premature rupture of membranes, even weeks after operation, an d infection of mother or fetus. Two out of twenty-one mothers required trea tment in our intensive-care unit. We conclude that emergency cerclage is a useful tool to prolong pregnancies at high risk of abortion. Nevertheless a n individualised management especially in patients after sterility therapy and a thorough postoperative control are required, due to the relatively hi gh incidence of infectious complications in mother and fetus.