A new technique for emergency cerclage: Guard suture method.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Innovation

Background:

• Cervical insufficiency with prolapsed membranes poses a significant risk for preterm birth.
• Emergency cerclage is a critical intervention to prolong pregnancy in such cases.
• Evaluating novel surgical techniques is essential for improving maternal and neonatal outcomes.

Purpose of the Study:

• To introduce and evaluate a novel guard suture technique for emergency cervical cerclage in mid-trimester pregnancies with prolapsed membranes.
• To compare the outcomes of the guard suture method with the traditional McDonald method.
• To assess the impact of the technique on pregnancy prolongation and neonatal well-being.

Main Methods:

• Retrospective study of 38 singleton pregnancies between 16-28 weeks gestation undergoing emergency cervical cerclage.
• Patients were divided into McDonald method (n=23) and guard suture method (n=15) groups.
• Key variables included gestational age at cerclage/delivery, cervical length, time to delivery, intraoperative complications, and neonatal outcomes (Apgar scores, NICU admission).

Main Results:

• The guard suture group demonstrated significantly higher 1st and 5th minute Apgar scores (p=0.04, p=0.01).
• Newborn intensive care unit (NICU) admission rates were significantly lower in the guard suture group (p=0.02).
• Mean gestational age at delivery was 33.9 weeks, with a mean prolongation of pregnancy of 80.42 days.

Conclusions:

• Emergency cervical cerclage, particularly using the guard suture method, is effective in prolonging pregnancy for cases of cervical insufficiency with prolapsed membranes.
• The guard suture technique is associated with improved neonatal outcomes, including better Apgar scores and reduced NICU admissions.
• The guard suture method is a safe, effective, and easily applicable option for obstetricians managing these high-risk pregnancies.