Emergency cervical cerclage: A review of 15 cases

Background: This report describes our experience with 15 consecutive emerge ncy cervical cerclages performed at Al Yamamah Hospital. Patients and Methods: Between February 1994 and February 1997, 15 women wit h singleton pregnancies between 18 and 26 weeks' gestation, with a cervical dilatation between 3 and 10 cm and with membrane prolapse, underwent emerg ency cerclage after excluding labor, placental abruption and intrauterine i nfection. The membranes were replaced using the technique of overfilling th e urinary bladder and then performing McDonald' s cerclage. All the patient s received prophylactic antibiotics and tocolytics. Results: Of the 15 pregnancies, two aborted and 13 ended in live births. Ni ne of the live births survived, giving a survival rate of 60%. The mean ext ension of pregnancy in the survivors was 11.5 weeks (range 7.6-15.2 weeks), and the gestational age at delivery ranged from 30-38+ weeks. In six of th e patients, suture failed to prolong the pregnancy long enough to produce a "take-home baby." All the failures were due to subclinical intrauterine in fection. There was no maternal morbidity. Conclusion: Emergency cerclage should be considered as a management option in women with painless cervical dilatation and membrane prolapse in the mid trimester.