[Emergency cervix cerclage in amniotic sac prolapse--a realistic option for prolonging pregnancy].
BACKGROUND
We tried to evaluate, whether emergency operative closure of the cervix (EOCC) is a realistic option for prolongation of pregnancy in cases with early opening of the cervix and prolapse of the amniotic sac (PAS) into the vagina.


METHODS
We report on 16 patients with PAS between 15 + 3 and 28 + 1 weeks of gestation and cervix dilatation between 2 and 8 cm. After antibiotic and tocolytic treatment we performed EOCC in 7 cases and EOCC + Cerclage in 9 cases. Pregnancy follow up and fetal outcome were analysed retrospectively.


RESULTS
Mean gestational age at delivery was 33 + 1 weeks (9 cases > 32 + 0 weeks, 2 cases between 28 + 0 and 31 + 6 weeks, 3 cases between 25 + 0 and 27 + 6 weeks, 1 case with rupture of membranes during operation and immediate cesarean section at 28 + 1 weeks, 1 miscarriage at 23 + 3 weeks). Time between EOCC and delivery was between 0 and 146 days (mean 56.3 days), 14 fetuses survived healthy. The best results were obtained after EOCC + cerclage.


CONCLUSIONS
If antibiotic and tocolytic treatment was successful in stopping local infection and contractions, EOCC is an acceptable and mostly successful procedure to prolong pregnancy.
Klinik für Geburtshilfe und Pränatalmedizin am HSK-Klinikum Wiesbaden.
T
T
Hitschold
P
P
Berle
M
M
Gonser
D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple; D013536:Suture Techniques; D015145:Tocolysis; D002581:Uterine Cervical Incompetence / Q000601:surgery*