The CLIPED procedure: an attempt to improve perinatal outcome in hopeless situations.
The purpose of this study was to prevent delivery in women who at < 23 weeks' gestation were in premature labor with excessive cervical dilation and membranes prolapsed into the vagina. Six patients were seen at gestational ages of 17 to 22.5 weeks in premature labor with cervical dilatation of 2 to 8 cm and membranes prolapsed into the vagina. There were three singleton pregnancies, two sets of twins, and one set of triplets. Cerclage placement was successful in five of six patients and one patient had ruptured membranes at operation. One fetus died the day after successful cerclage. The average prolongation of gestation was 33 days in the remaining four patients. It is our opinion that the poor prognosis of a patient at < 23 weeks' gestation in premature labor with excessive cervical dilatation and membranes prolapsed into the vagina may be altered with cerclage placement. We suggest that patients at > or = 21 weeks' gestation with prolapsed membranes whose contractions have been stopped be considered for cerclage late in pregnancy with excessive dilation (CLIPED procedure). The average amount of time a gestation is prolonged may preclude the procedure before 21 weeks.
Weinstein
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L
Department of Obstetrics and Gynecology, Medical College of Ohio, Toledo, 43699-0008, USA.
Okin
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Fellens
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D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature; D018743:Perinatal Care; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D011272:Pregnancy, Multiple; D013536:Suture Techniques / Q000009:adverse effects