Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy

In a cohort of 43 women with viable, singleton pregnancies, cervical dilatation greater than 4 cm, and absent labor between 20 and 27 weeks gestation, 22 women who underwent emergency cerclage within six hours of admission, were compared prospectively with 15 women who elected conservative bed rest treatment. The two groups were demographically similar. Emergency cervical cerclage resulted in a longer mean gestational age at delivery compared to bed rest (p = 0.001). Women treated with cerclage required a significantly shorter period of antepartum hospitalization (p = 0.001), required less tocolysis (p = 0.005), and experienced fewer preterm membrane ruptures compared to women in the bed rest group (p = 0.01), although the latency period, following preterm rupture of membranes was shorter in the cerclage group (p = 0.005). There was no statistical difference in the frequencies of chorioamnionitis, maternal morbidity and cesarean section between the two groups. Although the perinatal mortality in the two groups was not significantly different (p = 0.3), emergency cerclage resulted in a significantly higher mean birth weight compared to conservative bed rest treatment (p = 0.02). This study demonstrates the superiority of emergency cerclage to bed rest in women with advanced cervical dilatation and absent labor in late second-trimester of pregnancy.