title: Emergency Cerclage: Improvement of Outcomes by Standardization of Management.
abstract: BACKGROUND
  Cervical dilatation followed by prolapse and ballooning of membranes into the vagina at mid-gestation is a critical situation. The aim of this study was to describe the outcome of emergency cerclage in a tertiary referral center during a 10-year period (2001-2010) in which a defined selection of women and standard protocol were introduced.
  
  
  METHODS
  Thirty-nine cases of emergency cervical cerclage performed before 24 completed weeks were retrospectively reviewed. Data related to maternal history, diagnosis, procedure details, postoperative management and perinatal outcome were recorded. Maternal characteristics and perinatal outcomes are described.
  
  
  RESULTS
  Gestational age at cerclage (mean ± SD) was 22.1 ± 2.0 weeks with 61% (24/39) of women presenting bulging membranes. Gestational age at delivery and cerclage-to-delivery time (mean ± SD) were 28.6 ± 6.2 weeks and 49.1 ± 36.5 days, respectively. Only 38.5% (15/39) of the whole group and 44.1% (15/34) of those who reached 24.0 weeks delivered beyond 28 weeks of gestational age. Neonatal survival before discharge was 82.4% (28/34).
  
  
  CONCLUSIONS
  Perinatal outcomes after emergency cerclage are still poor with more than half of the cases delivering before 28 weeks. A standard protocol may help in the management of these rare cases.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clx00ED;nic and Hospital Sant Joan de Dx00E9;u), Fetal i+D Fetal Medicine Research Center, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Mariona
authors.initials: M
authors.lastname: Rius
authors.forename: Teresa
authors.initials: T
authors.lastname: Cobo
authors.forename: Raúl
authors.initials: R
authors.lastname: García-Posadas
authors.forename: Sandra
authors.initials: S
authors.lastname: Hernández
authors.forename: Irene
authors.initials: I
authors.lastname: Teixidó
authors.forename: Enrique
authors.initials: E
authors.lastname: Barrau
authors.forename: Carmen
authors.initials: C
authors.lastname: Abad
authors.forename: Montse
authors.initials: M
authors.lastname: Palacio
mesh_terms: D023802:Cerclage, Cervical / Q000592:standards*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007747:Labor Stage, First; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*