Balloon replacement of fetal membranes to facilitate emergency cervical cerclage.
BACKGROUND
Emergency cerclage can be used in cases of cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure we used a balloon device to replace the fetal membranes.


METHODS
With the patient in a steep Trendelenburg position, after epidural anesthesia, the fetal membranes were replaced into the uterine cavity with an inflated balloon of the type used for endoscopic preperitoneal dissection. Cervical cerclage was done by the McDonald technique.


RESULTS
We have done 25 emergency cerclages with this technique. The following maternal and perinatal outcomes were assessed retrospectively: age, medical history, gestational age at inclusion and delivery, cervical dilatation at admission, preterm rupture of membranes, clinical or histologic chorioamnionitis, birth weight, admission to the neonatal intensive care unit, neonatal death, and postnatal course.


CONCLUSIONS
Replacing prolapsed fetal membranes with an inflated balloon is a convenient technique that allows gestation to be prolonged for an average of 31 days. Cerclage was feasible when the cervix was widely dilated (more than 4 cm); it was associated with prolongation of gestation by a median of 9 days.
Tsatsaris
V
V
Department of Obstetrics and Gynecology, Hôpital Antoine Béclère, Clamart, France.
Senat
M V
MV
Gervaise
A
A
Fernandez
H
H
D004630:Emergencies; D005321:Extraembryonic Membranes / Q000473:pathology; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D013513:Obstetric Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011391:Prolapse; D002581:Uterine Cervical Incompetence / Q000601:surgery*