Infant outcomes following midtrimester emergency cerclage in the presence of fully dilated cervix and prolapsing amniotic membranes into the vagina


Akkurt M. O. , Yavuz A., SEZİK M. , ÖZKAYA M. O.

JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE, vol.29, no.15, pp.2437-2441, 2016 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 29 Issue: 15
  • Publication Date: 2016
  • Doi Number: 10.3109/14767058.2015.1087495
  • Title of Journal : JOURNAL OF MATERNAL-FETAL & NEONATAL MEDICINE
  • Page Numbers: pp.2437-2441

Abstract

Objective: To investigate the morbidity of infants, whose delivery was prolonged by an emergency cervical cerclage (EC).Methods: Ante- and postnatal data on subsequent EC procedures performed between 14 and 28 weeks of gestation for advanced cervical dilatation with prolapsing of amniotic membranes at a single institution within a 5-year-period were retrieved.Results: We identified 21 fetuses from 18 pregnancies. Median gestational age [interquartile range, IQR] at EC and prolongation of pregnancy was 21.5 [15-26] weeks and 49.3 [24-92] days, respectively. There were 4 (19%) stillbirths, 3 (14%) neonatal deaths, and 1 (5%) infant death. Ten infants (59% of livebirths) were admitted to neonatal intensive care unit and hospitalized for a median period of 11 [6-66] d. Of the surviving fetuses (14/21, 66.7%), 9 (42.8%) were intact, whereas 3 (17.6% of livebirths) had cerebral palsy (CP), 1 was diagnosed with hypothyroidism, and another had growth failure at 12 months of follow-up.Conclusion: EC seems to be beneficial only in a subset of pregnancies presenting with full cervical dilatation accompanied by prolapsing amniotic membranes into the vagina, and there is a requirement for more objective selection criteria. Neonatal morbidity, especially neurodevelopmental disability should be discussed thoroughly prior to this procedure.