Emergent and elective cervical cerclage for cervical incompetence

Area of Science:

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

Background:

• Cervical insufficiency is a leading cause of preterm birth.
• McDonald cerclage is a surgical procedure to prevent preterm birth.
• The efficacy of emergent cerclage, especially with prolapsed membranes, requires further investigation.

Purpose of the Study:

• To compare the clinical outcomes of emergent versus elective McDonald cerclage.
• To evaluate the effectiveness of cervical cerclage in cases with prolapsed amniotic sac.

Main Methods:

• Retrospective analysis of 48 patients undergoing elective cerclage and 21 patients undergoing emergent cerclage.
• Inclusion of 8 cases with prolapsed fetal membranes in the emergent group.
• Comparison of pregnancy prolongation, delivery timing, birth weight, fetal salvage, and Apgar scores.

Main Results:

• Elective cerclage resulted in significantly longer pregnancy duration (145 vs. 58 days) and later delivery (37.0 vs. 28.3 weeks).
• Higher birth weight (3033 vs. 1410 g), improved fetal salvage rate (98% vs. 52%), and better Apgar scores were observed in the elective group.
• No significant difference in outcomes was found between patients with and without prolapsed membranes, likely due to small sample size.

Conclusions:

• Elective McDonald cerclage offers superior clinical outcomes compared to emergent cerclage.
• The procedure is recommended for emergency cases, including those with prolapsed amniotic sac, to improve fetal salvage.