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Does rescue cerclage work?
Durai Shivani1, Bin Huey Quek2, Pih Lin Tan2
1Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore, Tel.: +65 97366679.
Rescue cervical cerclage (RCC), also known as emergency cerclage, has long been the subject of controversy. Its use in women who have a dilated cervix has been ambivalent. RCC is often considered as a salvage measure for pregnancies which are at a high risk of severe preterm delivery (PTD) or mid-trimester miscarriage. This study aims to examine and assess the efficacy of RCC and its ability to prolong pregnancy until neonatal viability is achieved. The current data suggest that RCC is associated with a longer latency period frequently resulting in better pregnancy outcomes (Namouz S, Porat S, Okun N, Windrim R, Farine D. Emergency cerclage: literature review. Obstet Gynecol Surv. 2013;68:379-88). This is supported by the Royal College of Obstetricians and Gynaecologists (RCOG) which states that the insertion of a rescue cerclage may delay delivery by a further 5 weeks on average as compared with expectant management or bed rest alone (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). It further states that it may be associated with a two-fold reduction in the possibility of delivery before 34 weeks of gestation (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). Our study reveals that the average insertion to delivery interval at our centre was 71.2 days with a live birth rate of 92.5%. A total of 89.1% of women delivered beyond 24 weeks of gestation.
Rescue cervical cerclage (RCC), also known as emergency cerclage, has long been the subject of controversy. Its use in women who have a dilated cervix has been ambivalent. RCC is often considered as a salvage measure for pregnancies which are at a high risk of severe preterm delivery (PTD) or mid-trimester miscarriage. This study aims to examine and assess the efficacy of RCC and its ability to prolong pregnancy until neonatal viability is achieved. The current data suggest that RCC is associated with a longer latency period frequently resulting in better pregnancy outcomes (Namouz S, Porat S, Okun N, Windrim R, Farine D. Emergency cerclage: literature review. Obstet Gynecol Surv. 2013;68:379-88). This is supported by the Royal College of Obstetricians and Gynaecologists (RCOG) which states that the insertion of a rescue cerclage may delay delivery by a further 5 weeks on average as compared with expectant management or bed rest alone (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). It further states that it may be associated with a two-fold reduction in the possibility of delivery before 34 weeks of gestation (Shennan AH. To MS: RCOG Green Top Guidelines: Cervical Cerclage RCOG.2011. Available from: www.rcog.org.uk). Our study reveals that the average insertion to delivery interval at our centre was 71.2 days with a live birth rate of 92.5%. A total of 89.1% of women delivered beyond 24 weeks of gestation.
