Emergency McDonald cerclage with application of stay sutures

To evaluate the efficiency of emergency cervical cerclage, and the use of stay sutures.

Retrospective review of patients who were treated with emergency cervical cerclage at our department between January 1984 and April 1994. McDonald cerclage, after traction of the cervix with 6-10 stay sutures, was inserted in 16 women between 16 and 28 weeks gestation, presenting with dilated cervix and protruding membranes. Tocolytics and prophylactic antibiotics were given to most patients.

All cerclage operations were primarily performed without complications, except in one case where membranes ruptured during operation. Two reoperations were necessary, and were successfully performed. The median duration of pregnancy after the procedure was 4.5 weeks (range 1 day-18 weeks), and the median birth weight was 1250 g (range 130-4330 g). In 10 of 16 patients (63%), the duration of pregnancy prolongation was between 2.5 and 18 weeks (median 7.0 weeks) following cerclage, with a median birth weight of 2145 g (range 995-4330 g). Four of these patients (25%) delivered at term. In the other six patients, pregnancy lasted seven days or less, resulting in four abortions, and two surviving infants. Eleven of the 16 pregnancies (69%) resulted in live infants.

Pregnancy can be significantly prolonged following emergency cervical cerclage, and the procedure may contribute to improved neonatal outcome.