Emergency cervical cerclage. Does the gestational age make a difference?

OBJECTIVE: To investigate the effectiveness of emergency cervical cerclage in prolongation of pregnancy and its effect on pregnancy outcome in patients with cervical incompetence.

METHODS: A retrospective review of patients who had an emergency cervical cerclage performed for cervical incompetence during the period from July 1995 to June 2002 was carried out in Abha General Hospital, Abha, Kingdom of Saudi Arabia. Twenty patients between 16 and 26 weeks of gestation with 1) cervical effacement, 2) cervical dilatation of </=3 cm, 3) herniation of intact fetal membranes through the cervical os, 4) absence of established labor, and 5) absence of clinical evidence of infection were studied. The duration of cerclage in situ, gestation at delivery and birth weight were analyzed.

RESULTS: The mean duration of cerclage in situ was 68.5 days. The mean gestation at delivery was 30.5 weeks and the mean birth weight was 1844 grams. The duration of cerclage in situ was significantly longer when the procedure was performed at or before 22 weeks of gestation with a p value of <0.02 (Mann-Whitney U test), but the difference in the gestation at delivery and birth weight was not significant. There was also a significant negative correlation between the gestation at cerclage and the duration of cerclage in situ (Spearman's correlation coefficient rs = -0.56, p<0.05).

CONCLUSION: Emergency cervical cerclage in early second trimester effectively prolonged pregnancy compared to emergency cerclage performed in late second trimester.