title: Impaired Neonatal Outcome after Emergency Cerclage Adds Controversy to Prolongation of Pregnancy.
abstract: OBJECTIVE
  Emergency cervical cerclage is one of the treatment options for the reduction of preterm birth. The aim of this study is to assess neonatal outcome after cerclage with special focus on adverse effects in very low birth weight infants.
  
  
  METHODS
  Retrospective cohort study. Classification of cerclages in history-indicated (HIC, n = 38), ultrasound-indicated (UIC, n = 29) and emergency/ physical examination-indicated (PEIC, n = 33) cerclage. Descriptive analysis of pregnancy and neonatal outcome (admission to NICU, duration of hospitalization, respiratory outcome (intubation, CPAP, FiO2max), neonatal complications (ROP, IVH)). Statistical comparison of perinatal parameters and outcome of neonates <1500 g after cerclage with a birth weight matched control group.
  
  
  RESULTS
  Neonates <1500 g after PEIC show significantly impaired outcome, i.e. prolonged respiratory support (total ventilation in days, CPAP, FiO2max) and higher rates of neonatal complications (IVH ≥ II, ROP ≥ 2). Placental pathologic evaluation revealed a significantly higher rate of chorioamnionitis (CAM) after PEIC. Neonates <1500 g after UIC or HIC show no significant difference in neonatal complications or CAM.
  
  
  CONCLUSIONS
  In our study PEIC is associated with adverse neonatal outcome in infants <1500 g. The high incidence of CAM indicates a potential inflammatory factor in the pathogenesis. Large well-designed RCTs are required to give conclusive answers to the question whether to prolong or to deliver.
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Ruben-J
authors.initials: RJ
authors.lastname: Kuon
authors.affiliation: Department of Neonatology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Hannes
authors.initials: H
authors.lastname: Hudalla
authors.affiliation: Department of Neonatology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Seitz
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Hertler
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Gawlik
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Fluhr
authors.affiliation: Department of Neonatology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Gausepohl
authors.affiliation: Department of Obstetrics and Gynecology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Sohn
authors.affiliation: Department of Neonatology, Heidelberg University Hospital, 69120, Heidelberg, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Pöschl
authors.affiliation: Department of Obstetrics and Gynecology, Kath. Marienkrankenhaus, 22087, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Maul
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D036861:Delivery, Obstetric; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome