title: Amnioreduction in patients with bulging prolapsed membranes out of the cervix and vaginal orifice in cervical cerclage.
abstract: OBJECTIVE
  To determine whether an amnioreduction via bulging membranes (AVBM) and cerclage could be useful in 17 women with singleton gestations demonstrating hourglass membranes bulging out of the cervix or vaginal orifice.
  
  
  METHODS
  We used the following selection criteria for AVBM under ultrasonographic guidance using a peit needle because of undetectable cervical edges: (type 1) the bag of membranes protruded beyond the inlet of the vagina; (type 2) the bag of huge membranes completely occupied the vagina.
  
  
  RESULTS
  Eight patients (three cases of type 1 and five of type 2) were successful in AVBM and cerclage at 22.1 +/- 2.2 weeks gestation (range 19-24 weeks), and mean birth weight was 1,048.1 +/- 801.6 g (range 302-2,688 g). Although the diameter of the forewater by transabdominal ultrasonography (cm) was higher than in the nine patients without AVBM (6.7 +/- 1.1 versus 4.1 +/- 0.7 cm, p = 0.002), the prolongation of pregnancy (32.9 +/- 46.2 days; range 2-133 days) was the same as in patients without AVBM (36.9 +/- 39.3 day, p = 1.000).
  
  
  CONCLUSIONS
  It is important that every effort should be made to perform cervical cerclage at or before 26 weeks of gestation, even in women with type 1 or 2.
authors.affiliation: Department of Obstetrics and Gynecology, School of Medicine, Fukuoka University, Fukuoka, Japan. makino1208@nifty.com
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Makino
authors.forename: Ikuko
authors.initials: I
authors.lastname: Makino
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tsujioka
authors.forename: Tatsuhiko
authors.initials: T
authors.lastname: Kawarabayashi
mesh_terms: D000328:Adult; D000650:Amnion / Q000473:pathology*; D023802:Cerclage, Cervical / Q000379:methods; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000000981:diagnostic imaging / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal