Management of cervical insufficiency and bulging fetal membranes

OBJECTIVE: To evaluate the efficacy of emergency cerclage in cases with dilated cervix and protruding fetal membranes in a group of women considered at low risk for preterm delivery by their obstetric histories. METHODS: All cases of cervical dilatation and bulging membranes were detected through a transvaginal ultrasonographic screening for preterm delivery between 18 and 26 weeks during a 6-year study period. Twenty-nine women underwent an emergency cervical cerclage and composed the cerclage group, whereas 17 others refused and formed the bed rest group. All patients were given antibiotics and prophylactic tocolysis. RESULTS: The mean prolongation of pregnancy (8.8 weeks) and the mean birth weight (2,101 g) after cerclage placement differed significantly from those of the bed rest group (3.1weeks and 739 g, respectively). Twenty-five of the 29 pregnancies in the cerclage group ended in live birth, compared with 7 of the 17 pregnancies in the bed rest group (P = .001) (relative risk [RR] 0.33, 95% confidence interval [CI] 0.11-0.98). Neonatal survival was 96% in the cerclage group and 57.1% in the bed rest group (P = .025) (RR 0.09, 95% CI 0.01-0.76). The preterm delivery rate less than 32 weeks was 31% and 94.1% in the cerclage and the bed rest groups, respectively (P < .001) (RR 0.33, 95% CI 0.19-0.57), whereas the admission to neonatal intensive care unit was 28% and 85.7% in the 2 groups, respectively, (P = .01) (RR 0.33, 95% CI 0.16-0.66). CONCLUSION: Emergency cervical cerclage can be accomplished safely in women with dilated cervix and bulging membranes. It can reduce preterm delivery before 32 weeks and improve neonatal survival compared with bed rest.