EMERGENCY CERVICAL SUTURE - THE OBSTETRICIANS DILEMMA

We studied the perinatal mortality and morbidity associated with emerg ency cervical suture at Royal North Shore Hospital over 7 years. There were 23 patients who had an emergency cervical suture inserted and th ey were divided into 3 groups for analysis, Group 1: patients with cer vical dilatation initially detected on routine 18-20 week ultrasonogra phy and later confirmed on clinical examination, Group 2: cervical dil atation less than or equal to 3 cm and Group 3: cervical dilatation >3 cm at presentation. The median delay in delivery in each group was 6, 5 and 3 weeks respectively. The perioperative membrane rupture rate f or emergency suture insertion in this study was 13%, The perinatal mor tality rate for each group was 0%, 33% and 43% respectively with an ov erall rate of 33%, Follow-up at 3-5 years of 9 babies with a birth-wei ght less than or equal to 1,000g, revealed that of 6 survivors, 1 had moderate disability and 2 had mild disability. No survivors had severe disability. From the results of our study, emergency cervical suture can prolong gestation and in the absence of prolapsed fetal membranes, the perioperative membrane rupture rate is low. However, it is import ant to consider that the time gained from emergency cervical suture in sertion may convert a previable fetus into an extremely premature infa nt with the risk of long-term disability.