Balloon replacement of fetal membranes to facilitate emergency cervical cerclage

BACKGROUND: Emergency cerclage can be used in cases of cervical incompetenc e, even when fetal membranes bulge through the dilated cervix. To facilitat e the procedure we used a balloon device to replace the fetal membranes. TECHNIQUE: With the patient in a steep Trendelenburg position, after epidur al anesthesia, the fetal membranes were replaced into the uterine cavity wi th an inflated balloon of the type used for endoscopic preperitoneal dissec tion. Cervical cerclage was done by the McDonald technique. EXPERIENCE: We have done 25 emergency cerclages with this technique. The fo llowing maternal and perinatal outcomes were assessed retrospectively: age, medical history, gestational age at inclusion and delivery, cervical dilat ation at admission, preterm rupture of membranes, clinical or histologic ch orioamnionitis, birth weight, admission to the neonatal intensive care unit , neonatal death, and postnatal course. CONCLUSION: Replacing prolapsed fetal membranes with an inflated balloon is a convenient technique that allows gestation to be prolonged for an averag e of 31 days. Cerclage was feasible when the cervix was widely dilated (mor e than 4 cm); it was associated with prolongation of gestation by a median of 9 days. (C) 2001 by the American College of Obstetricians and Gynecologi sts.