title: Emergency cerclage versus expectant management for prolapsed fetal membranes: a retrospective, comparative study.
abstract: OBJECTIVE
  To compare outcomes after emergency cerclage versus expectant management for prolapsed fetal membranes in women with cervical incompetency.
  
  
  METHODS
  The January 2000-December 2012 hospital database was analyzed to identify women managed for prolapsed fetal membranes who did not have premature rupture of membranes, clinically discernible chorioamnionitis, or treatment-resistant uterine contractions from 15 to 26 weeks of gestation retrospectively. Durations of pregnancy prolongation and numbers of deliveries after 32 and 28 weeks were compared between women undergoing emergency cervical cerclage and those receiving expectant management.
  
  
  RESULTS
  Fifteen of the 35 women underwent emergency cervical cerclage ('cerclage group'), while the other 20 were managed expectantly ('bedrest group'). In the cerclage group, median gestational ages at procedure and delivery times were 22.6 (15.9-26.1) and 32.4 (19.4-41.6) weeks, respectively. Median gestational ages on admission and at delivery in the bedrest group were 23.4 (21.1-26.4) and 26.0 (23.1-36.4) weeks, respectively. The median duration of pregnancy prolongation was 44 days (4-165) in the cerclage group and 12.5 days (2-93) in the bedrest group (P < 0.01). Numbers of deliveries after 28 and 32 weeks were both significantly higher in the cerclage than in the bedrest group (P < 0.05).
  
  
  CONCLUSIONS
  In women with prolapsed fetal membranes but no signs of infection or painful uterine contractions, emergency cervical cerclage prolonged pregnancy duration as compared with expectant management.
authors.affiliation: Perinatal Center for Maternity and Neonate, Yokohama City University Medical Center, Yokohama, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Aoki
authors.forename: Emi
authors.initials: E
authors.lastname: Ohnuma
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kurasawa
authors.forename: Mika
authors.initials: M
authors.lastname: Okuda
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Takahashi
authors.forename: Fumiki
authors.initials: F
authors.lastname: Hirahara
mesh_terms: D000328:Adult; D001510:Bed Rest; D023802:Cerclage, Cervical; D005321:Extraembryonic Membranes; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D047928:Premature Birth / Q000209:etiology / Q000517:prevention & control*; D011391:Prolapse; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000628:therapy*; D057832:Watchful Waiting
keywords: cervical insufficiency; emergency cerclage; expectant management; prolapsed fetal membrane; prolongation of pregnancy