title: To do or not to do emergency cervical cerclage (a rescue stitch) at 24-28 weeks gestation in addition to progesterone for patients coming early in labor? A prospective randomized trial for efficacy and safety.
abstract: OBJECTIVE
  To measure the outcome of emergency cervical cerclage (ECC) combined with progesterone vs. progesterone alone in pregnancy prolongation for preterm labor at 24-28 weeks.
  
  
  METHODS
  One hundred patients in early labor were allocated randomly into two equal groups. Group A were treated by ECC and progesterone, and group B were on the same progesterone dose only treatment.
  
  
  RESULTS
  No significant differences were observed in both groups as regard demographic data, fetal gestational age or cervical state on admission. However, a significant pregnancy prolongation was observed in group A (28.44 ± 12.73 days vs. 9.96 ± 3.27 in group B, p < 0.001) with subsequent increase in fetal gestational age (32.04 ± 3.2 vs. 27.86 ± 3.213, p < 0.001), heavier weight, higher Apgar score at 1 and 5 min, and lower rate of cesarean delivery (1033.1 ± 170.83 vs. 715.1 ± 138.73, p < 0.001) (2.68 ± 1.132 vs. 2.14 ± 0.93, p < 0.001), (5.48 ± 2.6 vs. 2.38 ± 1.59, p = 0.01) and (16 vs. 62 %, p = 0.01), respectively. Also neonatal outcomes in terms of early neonatal deaths were lower in this group (18 vs. 46 %, p = 0.049).
  
  
  CONCLUSIONS
  ECC is effective in pregnancy prolongation when judiciously used in combination with progesterone compared to progesterone alone.
authors.affiliation: Department of Obstetrics and Gynecology, Mansoura College of Medicine, Mansoura University, Mansoura, Egypt. aragab69@yahoo.com.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ragab
authors.affiliation: Department of Obstetrics and Gynecology, Mansoura College of Medicine, Mansoura University, Mansoura, Egypt.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Mesbah
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D002585:Cesarean Section; D004630:Emergencies; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011273:Pregnancy, Prolonged; D047928:Premature Birth / Q000517:prevention & control*; D011374:Progesterone / Q000008:administration & dosage*; D011446:Prospective Studies; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*
chemical_list: D011374:Progesterone
keywords: Cerclage; Emergency; Labor; Preterm