title: Emergency cerclage: literature review.
abstract: This article reviews the use and effectiveness of emergency cerclage for women who present with a dilated cervix in the second trimester of pregnancy and seeks to identify predictors of favorable emergency cerclage outcomes. We searched PubMed and the Cochrane Library for the period January 1995 to April 2012 and used the terms "emergency cerclage," "emergency stitch," "rescue cerclage," and "rescue stitch." Thirty-four studies in which transvaginal emergency cervical cerclage was performed in women with a dilated cervix were identified and included. Predictors of poor outcome were prolapsed membranes, evidence of intra-amniotic or systemic infection, symptomatic presentation, cervical dilatation greater than 3 cm, or cerclage after 22 weeks. According to observational and limited randomized controlled trials, the cerclage group did significantly better than the bed-rest group in mean randomization-to-delivery interval, preterm delivery before 34 weeks, and compound neonatal morbidity. The current data suggest that emergency cerclage is associated with a longer latency period and, most often, with better pregnancy outcomes when compared with bed rest. Many of the predictors of adverse outcomes appear to be associated with evidence of inflammation or infection.
  
  
  BACKGROUND
  Obstetricians and gynecologists, family physicians
  
  
  OBJECTIVE
  After completing this CME activity, physicians should be better able to review the use and evaluate the effectiveness of emergency cerclage for women who present with a dilated cervix in the second trimester, to identify predictors of favorable emergency cerclage outcomes, and to compare emergency cerclage versus bed rest.
authors.affiliation: Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Shirin
authors.initials: S
authors.lastname: Namouz
authors.forename: Shay
authors.initials: S
authors.lastname: Porat
authors.forename: Nan
authors.initials: N
authors.lastname: Okun
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: Dan
authors.initials: D
authors.lastname: Farine
mesh_terms: D001510:Bed Rest; D023802:Cerclage, Cervical; D004630:Emergencies; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy