Y. E. Abdelhak, R. Aronov, H. Roque, B. K. Young
Management of cervical cerclage at term: remove the suture in labor?
Objective: To assess the risks and benefits to patients
who carry to term after undergoing a Shirodkar cerclage
where the cerclage is not removed until the patient presents
in labor.
Methods: A retrospective analysis was conducted examining
all patients who underwent a Shirodkar cerclage
employing a 5 mm Mersilene band. All the cerclages
were placed by a single operator over a twenty
five year span, from 1/01/74 till 10/01/98. Only patients
who delivered vaginally or were allowed a trial of labor
were included. In all cases, the cerclage was removed
under regional anesthesia after the patient presented to
the hospital in labor.
Results: Ninety six cerclage procedures were performed
over that period. Eighty two pregnancies qualified for review. Sixty two patients delivered vaginally
(76%). Nine cesareans were indicated for failure to progress
in labor (11%) with cervical dystocia possibly implicated
in one. There were no cases of ruptured uteri
or the development of uterine windows. Of the 82 pregnancies
there were five cases (6%) of minor cervical
laceration.
Conclusion: Allowing patients to proceed to labor with
a Shirodkar cerclage in place, does not increase the risks
of cervical dystocia, cervical laceration, or uterine rupture
above the reported incidence for these complications
in patients in whom the cerclage is removed prophylactically.
Journal of Perinatal Medicine, Walter de Gruyter
Print ISSN: 1619-3997
Volume: 28, 11/2000
Pages: 453 - 457
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