title: A new technique using a rubber balloon in emergency second trimester cerclage for fetal membrane prolapse.
abstract: OBJECTIVE
  Prolongation of pregnancy in cases of fetal membrane prolapse into the vagina during the second trimester is difficult using conservative therapy. After pushing the membranes back into the cervix, emergency cervical cerclage may be advantageous in improving the neonatal outcome. We have been managing membrane repositioning and emergency cervical cerclage with a technique using a rubber balloon device (known as a 'mini metreu' in Japan), and we examined the efficacy of this technique in five cases.
  
  
  METHODS
  Our management was as follows: initially, the full bladder technique was attempted under general anesthesia. If this was not effective, amnioreduction was performed by transabdominal amniocentesis. After the membrane repositioning using a mini metreu, double suture cervical cerclage (McDonald method + Shirodkar method) was performed.
  
  
  RESULTS
  The diameter of the bulging prolapsed membranes ranged from 30-84 mm, with a mean of 52 mm. Cerclage was successfully performed in all of the five cases. Prolongation of the pregnancy period was from 22-107 days (average; 77.6 +/- 28.9 days). In cases 1-4, healthy newborns were delivered, but in case 5 sudden intrauterine fetal death due to umbilical cord complications occurred at 24 weeks of gestation.
  
  
  CONCLUSIONS
  It appears that long-term prolongation of pregnancy is possible, when performing membrane repositioning using the mini metreu and emergency cervical cerclage for fetal membrane prolapse into the vagina.
authors.affiliation: Department of Family and Child Nursing, and Midwifery, Shinshu University School of Health Sciences, Matsumoto, Nagano, Japan. makotok@shinshu-u.ac.jp
authors.forename: Makoto
authors.initials: M
authors.lastname: Kanai
authors.forename: Takashi
authors.initials: T
authors.lastname: Ashida
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ohira
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Osada
authors.forename: Ikuo
authors.initials: I
authors.lastname: Konishi
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005321:Extraembryonic Membranes / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011391:Prolapse; D002577:Uterine Cervical Diseases / Q000473:pathology / Q000601:surgery*