EMERGENCY CERVICAL CERCLAGE

Objective-To assess the efficacy of emergency cervical cerclage. Design-Retrospective review of patients who underwent emergency cervical cerclage between August 1986 and August 1989. Setting-University College and the Middlesex Hospitals obstetric unit, a neonatal referral centre. Subjects-19 women between 16 and 28 weeks gestation with a cervical dilatation between 3 and 10 cm. There were two twin pregnancies. Interventions-Amniocentesis and bacteriological assessments were performed prior to cerclage and prophylactic antibiotics were given. Insertion of sutures was aided by a combination of techniques described previously. Main outcome measures-Prolongation of gestation and pregnancy outcome. Bacteriological findings at delivery and maternal and fetal morbidity were also recorded. Results-Membranes remained intact in all the women after cerclage. Fifteen live babies were born and 13 of them survived (survival rate 63%). Gestation was prolonged from between 1 and 19 weeks in these patients and the gestational age at delivery ranged from 25 to 41 weeks. All eight intrauterine or neonatal deaths were associated with infection. Infecting organisms included Escherichia coli, Gardnerella vaginalis, Mycoplasma hominis, Trichomonas vaginalis and Fusobacterium spp. Pregnancy was prolonged for less-than-or-equal-to 5 weeks in these infected pregnancies. A cervical laceration occurred in a patient who had the suture inserted at full dilatation and subsequently laboured, but there were no other maternal complications. Conclusions-Emergency cervical cerclage can prolong pregnancy and influence the outcome favourably.