Ratko Matijevic, Branka Olujic, Jasua Tumbri, Asim Kurjak
Cervical incompetence: the use of selective and emergency cerclage
Objective: This prospective case series was performed
in order to assess pregnancy outcome of
women with tentative diagnosis of cervical incompetence
undergoing selective and emergency cervical
cerclage.
Methods: Women recruited in this case series were
divided into two groups. The selective group (n = 13)
was chosen among pregnant women with a history
suggestive of cervical incompetence, but no clinical
evidence of threatened miscarriage. The definition of
cervical incompetence was dilatation of internal cervical
os with shortening of the cervix less than 25 mm
and “funnelling” of 25% and more, found on the
ultrasound examination of the cervix. The emergency
group (n = 12) had clinical symptoms of threatened
miscarriage. After exclusion of infection and in the
absence of uterine activity they were counseled and
offered cerclage.
Results: After cervical cerclage all women were treated
in the same way as per our clinical protocol and monitored
until delivery. The median gestational age at delivery
was 36 weeks (19–39) in the selective group and
33 weeks (22–38) in the emergency group. This difference
is not statistically significant. There was 1 miscarriage
(8%), 5 pre-term deliveries (38%) and 7 term deliveries
(54%) in the selective group; and 4 miscarriages
(33%), 3 pre-term deliveries (25%) and 5 term
deliveries (42%) in the emergency group. Total neonatal
survival was 19/20 (95%) if pregnancy exceeded 24
weeks, making perinatal mortality 5%. There was no
differences between selective and emergency groups (1 of 12 in selective vs. 0 of 8 in emergency).
Conclusion: Overall, it can be concluded that both
selective and emergency cerclage may have some benefits
in patients with cervical incompetence. However,
in the absence of a randomized-controlled study, these
beneficial effects described cannot be considered as
proved.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 29, 01/2001
Pages: 31 - 35
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