Objectives: To evaluate the role of emergency cervical ccrclagc in prolongation of pregnancy and its effect on pregnancy outcome.
Patients & Methods: A prospective study of eleven patients who presented with a dilated cervical os and bulging fetal membranecs betwen 17 and 26 weeks of pregnancy.
Setting & Period: In Al Medina Maternity and Children's Hospital (MMCH), KSA. From 01/01/1426 to 30/05/142711. Results: The pre ccrclagc cervical length ranged from full cffaccmcnt to I cm, whereas the post ccrclagc length was 2-2.5 cm. Women were observed for 12-24 hours before a ccrclagc was inserted to rule out active labor, placental separation or infection. Prophylactic tocolytic in the form of magnesium sulphate (MgSO) was used in addition to a single agent antibiotic cover (amoxyclillin + clavulanic acid). The procedure was performed under general anesthesia using McDonald's type of stitch. With one exception, procedure failure, there were no pcriopcralivc complications. Women remained in the hospital for a median of (16.6+SD) days after ccrclagc (range 2 to 85 days). Pregnancy was prolonged by 61.6 days (range from 3 to 140 days). One woman aborted after 3 days, another woman required removal of ccrclage after 30 days due to active labor at 28 weeks gestation. Nine living infants, including one set of twins, were born (72.7%). Their median birth weight at delivery was 233l.25g (range from 1400 to 3000 g). Four women delivered at 37 weeks or more (36.36%). Two women delivered by ccsarcan section (18.18%). The mean gestalional age at delivery was 32.8 weeks (range from 22 to 38 weeks).
Conclusion: Emergency cervical ccrclagc is an important obstetric procedure with well defined operative risks. As such and until adequate clinical trials arc available demonstrating a clear benefit, emergency cervical ccrclagc i.s a treatment option for women presenting with advanced cervical dilatation with or without bulging membranes. It should be used judiciously and only after comprehensive patients' evaluation and selection as well as after extensive counseling.