Emergency cervical cerclage. Does the gestational age make a difference?
OBJECTIVE
To investigate the effectiveness of emergency cervical cerclage in prolongation of pregnancy and its effect on pregnancy outcome in patients with cervical incompetence.


METHODS
A retrospective review of patients who had an emergency cervical cerclage performed for cervical incompetence during the period from July 1995 to June 2002 was carried out in Abha General Hospital, Abha, Kingdom of Saudi Arabia. Twenty patients between 16 and 26 weeks of gestation with 1) cervical effacement, 2) cervical dilatation of < or =3 cm, 3) herniation of intact fetal membranes through the cervical os, 4) absence of established labor, and 5) absence of clinical evidence of infection were studied. The duration of cerclage in situ, gestation at delivery and birth weight were analyzed.


RESULTS
The mean duration of cerclage in situ was 68.5 days. The mean gestation at delivery was 30.5 weeks and the mean birth weight was 1844 grams. The duration of cerclage in situ was significantly longer when the procedure was performed at or before 22 weeks of gestation with a p value of <0.02 (Mann-Whitney U test), but the difference in the gestation at delivery and birth weight was not significant. There was also a significant negative correlation between the gestation at cerclage and the duration of cerclage in situ (Spearman's correlation coefficient rs = -0.56, p<0.05).


CONCLUSIONS
Emergency cervical cerclage in early second trimester effectively prolonged pregnancy compared to emergency cerclage performed in late second trimester.
Department of Obstetrics and Gynecology and Reproductive Medicine, College of Medicine, King Khalid University, PO Box 641, Abha, Kingdom of Saudi Arabia. mamdoheskandar@hotmail.com
Mamdoh A
MA
Eskandar
Adekunle A
AA
Sobande
Ian O
IO
Damole
Ahmed M
AM
Bahar
D000328:Adult; D000367:Age Factors; D023802:Cerclage, Cervical / Q000379:methods*; D004632:Emergency Medical Services; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012529:Saudi Arabia; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000175:diagnosis / Q000601:surgery*