title: Infant outcomes following midtrimester emergency cerclage in the presence of fully dilated cervix and prolapsing amniotic membranes into the vagina.
abstract: OBJECTIVE
  To investigate the morbidity of infants, whose delivery was prolonged by an emergency cervical cerclage (EC).
  
  
  METHODS
  Ante- and postnatal data on subsequent EC procedures performed between 14 and 28 weeks of gestation for advanced cervical dilatation with prolapsing of amniotic membranes at a single institution within a 5-year-period were retrieved.
  
  
  RESULTS
  We identified 21 fetuses from 18 pregnancies. Median gestational age [interquartile range, IQR] at EC and prolongation of pregnancy was 21.5 [15-26] weeks and 49.3 [24-92] days, respectively. There were 4 (19%) stillbirths, 3 (14%) neonatal deaths, and 1 (5%) infant death. Ten infants (59% of livebirths) were admitted to neonatal intensive care unit and hospitalized for a median period of 11 [6-66] d. Of the surviving fetuses (14/21, 66.7%), 9 (42.8%) were intact, whereas 3 (17.6% of livebirths) had cerebral palsy (CP), 1 was diagnosed with hypothyroidism, and another had growth failure at 12 months of follow-up.
  
  
  CONCLUSIONS
  EC seems to be beneficial only in a subset of pregnancies presenting with full cervical dilatation accompanied by prolapsing amniotic membranes into the vagina, and there is a requirement for more objective selection criteria. Neonatal morbidity, especially neurodevelopmental disability should be discussed thoroughly prior to this procedure.
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Perinatology , Suleyman Demirel University, School of Medicine , Isparta , Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ozgur Akkurt
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Perinatology , Suleyman Demirel University, School of Medicine , Isparta , Turkey.
authors.forename: And
authors.initials: A
authors.lastname: Yavuz
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Perinatology , Suleyman Demirel University, School of Medicine , Isparta , Turkey.
authors.forename: Mekin
authors.initials: M
authors.lastname: Sezik
authors.affiliation: a Department of Obstetrics and Gynecology, Division of Perinatology , Suleyman Demirel University, School of Medicine , Isparta , Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Okan Ozkaya
mesh_terms: D000328:Adult; D000650:Amnion; D023802:Cerclage, Cervical / Q000009:adverse effects / Q000379:methods*; D002584:Cervix Uteri / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000453:epidemiology / Q000209:etiology*; D007747:Labor Stage, First; D011183:Postoperative Complications; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000601:surgery*; D011391:Prolapse; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery*; D014621:Vagina
keywords: Cerebral palsy; emergency cerclage; neurodevelopmental outcome; preterm birth; rescue cerclage