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[Total cervix occlusion--an efficient measure in prolapsed amniotic membranes in extreme prematurity?]
A Artmann1, R Schuchardt, J Gnirs
1Abteilung für Perinatalmedizin und Perinatalphysiologie der Frauenklinik der Technischen Universität München, Klinikum rechts der Isar. almut.artmann@Irz.tum.de
Background:
We analysed retrospectively whether the total cervix occlusion implicates efficient the prolongation of pregnancy in patients with bulging fetal membranes during extreme prematurity.
Patients And Methods:
Between 1993 and 1999 nineteen pregnant women (17 singleton and 2 twin pregnancies) with cervical incompetence and bulging membranes at 20 to 27 weeks' gestation (mean 24 weeks) underwent total cervix occlusion (TCO) at the Department of Obstetrics at the Technische Universität of Munich after taking cervical cultures, prophylactic antibiotic treatment, tocolysis and induction of fetal lung maturity (after 33 weeks of gestational age).
Results:
Eleven of nineteen pregnancies were carried beyond 32 weeks' gestation. 6 of 21 fetuses, included 2 twin pregnancies died. Considering the perinatal mortality the mean prolongation of pregnancy was 9.4 weeks after total cervix occlusion. 9 of 19 pregnant women were delivered beyond 37 weeks of gestational age.
Conclusion:
Taking the small number and the lack of a randomized trial into consideration, these results implicate the total cervix occlusion as an efficient method in cases of bulging membranes during extreme prematurity. Nevertheless a thorough postoperative control and screening of infectious complications are required.