Emergency cervical cerclage: Relation between its success, preoperative serum level of C-reactive protein and WBC count, and degree of cervical dilatation

Objective: To assess the relation between the preoperative serum level of C -reactive protein (CRP) and the WBC count and the efficacy of emergency cer vical cerclage. Study Design: We retrospectively reviewed the medical recor ds of 17 women (16 singleton pregnancies and 1 twin pregnancy) who underwen t emergency cervical cerclage (McDonald technique) between 21 and 26 weeks of gestation. The uterine cervix was dilated greater than or equal to 3.0 c m and the intact (not ruptured) fetal membranes were visible or protruded i nto the vagina in all patients. The serum level of CRP and the WBC count we re determined preoperatively and postoperatively. Emergency cervical cercla ge was considered successful if delivery occurred greater than or equal to 14 days after the procedure. Results: Emergency cervical cerclage was succe ssful in 12 women, including the woman with a twin pregnancy, but failed in 5 women. The preoperative serum level of CRP and the WBC count were signif icantly lower and dilatation of the cervix was significantly less in the su ccess group than in the failure group. Cerclage was successful in all eight patients with cervical dilatation less than or equal to 4.0 cm, but in onl y 4 of 9 patients with cervical dilatation >4.0 cm (p < 0.05). Cerclage was successful in all 11 women with a preoperative serum level of CRP less tha n or equal to 4.0 mg/dl and a WBC count less than or equal to 14,000/mu l c ompared with 1 of 6 women with either a CRP level >4.0 mg/dl or a WBC count >14,000/mu l (p < 0.01). Conclusion: A preoperative CRP value less than or equal to 4.0 mg/dl, a WBC count less than or equal to 14,000/mu l, and cer vical dilatation less than or equal to 4.0 cm were significantly associated with prolongation of pregnancy after emergency cervical cerclage.