Total cervix occlusion - an efficient method in cases with bulging membranes during extreme prematurity?

Background: We analysed retrospectively whether the total cervix occlusion implicates efficient the prolongation of pregnancy in patients with bulging fetal membranes during extreme prematurity. Patients and Methods: Between 1993 and 1999 nineteen pregnant women (17 sin gleton and 2 twin pregnancies) with cervical incompetence and bulging membr anes at 20 to 27 weeks' gestation (mean 24 weeks) underwent total cervix oc clusion (TCO) at the Department of Obstetrics at the Technische Universitat of Munich after taking cervical cultures, prophylactic antibiotic treatmen t, tocolysis and induction of fetal lung maturity (after 33 weeks of gestat ional age). Results: Eleven of nineteen pregnancies were carried beyond 32 weeks' gesta tion. 6 of 21 fetuses, included 2 twin pregnancies died. Considering the pe rinatal mortality the mean prolongation of pregnancy was 9.4 weeks after to tal cervix occlusion. 9 of 19 pregnant women were delivered beyond 37 weeks of gestational age. Conclusion: Taking the small number and the lack of a randomized trial into consideration, these results implicate the total cervix occlusion as an ef ficient method in cases of bulging membranes during extreme prematurity. Ne vertheless a thorough postoperative control and screening of infectious com plications are required.