TY - JOUR
T1 - Should it really be called a heroic cerclage? The obstetrical results of emergency late second-trimester cerclage compared with early history-indicated elective cerclage
T2 - a retrospective trial
AU - Mor, Matan
AU - Levi, Amit
AU - Rafaeli-Yehudai, Tal
AU - Ezratty, Jodi
AU - Shiber, Yair
AU - Smorgick, Noam
AU - Vaknin, Zvi
N1 - Publisher Copyright:
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023.
PY - 2024/8/1
Y1 - 2024/8/1
N2 - Purpose: Women diagnosed with mid-trimester cervical insufficiency and dilatation are offered interventions to salvage and support the cervix, where the mainstay of therapy is emergency cervical cerclage. However, considering the significant morbidity associated with delivery in the extreme prematurity period, some women may opt for pregnancy termination. In addition, it is expected that elective cerclage in a subsequent pregnancy may yield better obstetrical results. The objective of this study was, therefore, to compare the obstetrical outcomes of emergency cerclage versus elective cerclage. Methods: This is a retrospective cohort study of the pregnancy outcomes of women with a singleton pregnancy who underwent cervical cerclage at our institution between December 2008 and November 2021. Women who underwent emergency cervical cerclage due to painless dilatation in the second trimester were compared with women who underwent elective cerclage. Results: Overall, 32 women who underwent emergency cerclage and 183 women who underwent elective cerclage were included. No cases of iatrogenic membrane rupture were noted during the cerclage procedure. There was no statistical difference between the emergency cerclage group and the elective cerclage group in the primary outcomes: gestational age at delivery (35.8 + 4.7 vs 36.3 + 4.9, p = 0.58, respectively), delivery in the extreme prematurity period (between 24 and 28 gestational weeks, 6.5% vs 2.3%, p = 0.21, respectively), and fetal or neonatal death (6.9% vs 6.3%, p = 0.91, respectively). Conclusion: Although there are much less favourable circumstances, emergency cerclage is a safe procedure with comparable obstetrical outcomes to elective cerclage. Patient selection and experienced medical team may play a significant role in those cases.
AB - Purpose: Women diagnosed with mid-trimester cervical insufficiency and dilatation are offered interventions to salvage and support the cervix, where the mainstay of therapy is emergency cervical cerclage. However, considering the significant morbidity associated with delivery in the extreme prematurity period, some women may opt for pregnancy termination. In addition, it is expected that elective cerclage in a subsequent pregnancy may yield better obstetrical results. The objective of this study was, therefore, to compare the obstetrical outcomes of emergency cerclage versus elective cerclage. Methods: This is a retrospective cohort study of the pregnancy outcomes of women with a singleton pregnancy who underwent cervical cerclage at our institution between December 2008 and November 2021. Women who underwent emergency cervical cerclage due to painless dilatation in the second trimester were compared with women who underwent elective cerclage. Results: Overall, 32 women who underwent emergency cerclage and 183 women who underwent elective cerclage were included. No cases of iatrogenic membrane rupture were noted during the cerclage procedure. There was no statistical difference between the emergency cerclage group and the elective cerclage group in the primary outcomes: gestational age at delivery (35.8 + 4.7 vs 36.3 + 4.9, p = 0.58, respectively), delivery in the extreme prematurity period (between 24 and 28 gestational weeks, 6.5% vs 2.3%, p = 0.21, respectively), and fetal or neonatal death (6.9% vs 6.3%, p = 0.91, respectively). Conclusion: Although there are much less favourable circumstances, emergency cerclage is a safe procedure with comparable obstetrical outcomes to elective cerclage. Patient selection and experienced medical team may play a significant role in those cases.
KW - Cervical insufficiency
KW - Double cerclage
KW - McDonald
KW - Physical examination cerclage
KW - Shirodkar
UR - http://www.scopus.com/inward/record.url?scp=85172920968&partnerID=8YFLogxK
U2 - 10.1007/s00404-023-07224-0
DO - 10.1007/s00404-023-07224-0
M3 - Article
C2 - 37773465
AN - SCOPUS:85172920968
SN - 0932-0067
VL - 310
SP - 1121
EP - 1129
JO - Archives of Gynecology and Obstetrics
JF - Archives of Gynecology and Obstetrics
IS - 2
ER -