title: Bridge Suture for Successful McDonald Emergency Cerclage.
abstract: OBJECTIVE
  To create awareness about a surgical technique termed bridge suture, which is performed as a pretreatment before a McDonald cerclage is performed on an emergency to treat severe cervical insufficiency.
  
  
  METHODS
  Procedures for bridge suture were reviewed in detail and outcomes of 16 patients treated with bridge suture followed by McDonald cerclage were evaluated retrospectively.
  
  
  RESULTS
  Using the bridge suture, the edges of uterine cervix were temporarily sutured and the external uterine os was closed, while the hourglass-shaped fetal membranes were concomitantly confined within the cervix; subsequently, a McDonald cerclage was performed. Over a 22-year period, 16 patients with a dilated cervix and bulging fetal membranes were treated using the technique of bridge suture followed by an emergency cerclage. The mean gestational age at cerclage was 22.5 weeks; the mean gestational age at delivery was 30.7 weeks; and the mean interval between cerclage and delivery was 8.2 weeks. In 15 out of 16 cases, cerclage was performed without encountering any complications. No maternal complications, including cervical laceration, were observed. The mean body weight of 17 neonates, including that of a twin, was 1,516 g and of them, 15 neonates survived.
  
  
  CONCLUSIONS
  The important outcome of bridge suture is the replacement of fetal membranes back into the uterine cavity before McDonald's cerclage is performed. Pretreatment with bridge suture may facilitate the performance of a successful emergency cerclage and contribute to good maternal and neonatal outcomes.
authors: Department of Obstetrics and Gynecology, Fukui Prefectural Hospital, Fukui, Japan.
authors: Masaaki
authors: M
authors: Tanaka
authors: Yoshiaki
authors: Y
authors: Hori
authors: Aya
authors: A
authors: Shirafuji
authors: Mitsunori
authors: M
authors: Kato
authors: Jyun
authors: J
authors: Kato
authors: Hiroto
authors: H
authors: Kobayashi
authors: Toru
authors: T
authors: Tsuchida
authors: Tsukasa
authors: T
authors: Fukae
mesh_terms: D000328:Adult; D001724:Birth Weight; D023802:Cerclage, Cervical / Q000379:methods*; D036861:Delivery, Obstetric; D004638:Emergency Treatment; D005321:Extraembryonic Membranes / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007747:Labor Stage, First; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D013536:Suture Techniques; D013537:Sutures; D002581:Uterine Cervical Incompetence / Q000601:surgery
keywords: Cervical insufficiency; Emergency cerclage; Stay suture