Emergent cervical cerclage: experience from a tertiary center.

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Cervical insufficiency (CI) is a major cause of late miscarriage and preterm birth (PTB) before 27 weeks.
• Emergent cerclage is effective for prolonging pregnancy and improving neonatal outcomes in cases of painless cervical dilation between 14 and 24 weeks.

Purpose of the Study:

• To evaluate the obstetric and neonatal outcomes of pregnancies with cervical insufficiency requiring emergent cerclage placement.

Main Methods:

• Retrospective cohort study at a European tertiary care university hospital.
• Included singleton pregnancies with painless midtrimester cervical dilation >1 cm, gestational age 14-24 weeks, and no signs of chorioamnionitis.
• Assessed subclinical infection via amniocentesis in cases of membrane exposure or sludge; primary outcome was delivery after 28 weeks.

Main Results:

• 44% of 18 women delivered after 28 weeks, with a median pregnancy prolongation of 49.3 days.
• Overall survival rate was 66.7%, viable fetal survival 72.2%, and neonatal survival 92.3%.
• Earlier diagnosis (<20 weeks) correlated with shorter latency and higher preterm chorioamnionitis rates (p<0.05).

Conclusions:

• Earlier diagnosis of cervical insufficiency is associated with shorter latency and increased risk of preterm chorioamnionitis.
• Emphasizes the importance of infection screening and individualized management for high-risk pregnancies.
• Suggests future research on optimizing patient selection and adjunctive therapies for emergent cerclage.