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Emergency cerclage compared with bed rest for advanced cervical dilatation in pregnancy.
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1996
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FertilityBed RestGynecologySurgeryCervical DilatationCaesarean SectionObstetricsFetal DistressPublic HealthPreterm Premature Rupture Of MembranesInfertilityEmergency CerclagePreterm LaborAdvanced Cervical DilatationMaternal ComplicationMaternal HealthEmergency Cervical CerclageCervical CancerPatient SafetyPregnancyPreterm BirthLabor And DeliveryMedicineWomen's Health
The two groups were demographically similar. A prospective comparison of 22 women receiving emergency cerclage within six hours of admission to 15 women opting for conservative bed rest was conducted in a cohort of 43 women with viable singleton pregnancies, cervical dilatation >4 cm, and no labor between 20 and 27 weeks gestation. Emergency cerclage led to a longer mean gestational age at delivery, shorter antepartum hospitalization, reduced tocolysis use, fewer preterm membrane ruptures, higher birth weight, and overall superiority over bed rest, without increasing chorioamnionitis, maternal morbidity, cesarean section, or perinatal mortality.
In a cohort of 43 women with viable, singleton pregnancies, cervical dilatation greater than 4 cm, and absent labor between 20 and 27 weeks gestation, 22 women who underwent emergency cerclage within six hours of admission, were compared prospectively with 15 women who elected conservative bed rest treatment. The two groups were demographically similar. Emergency cervical cerclage resulted in a longer mean gestational age at delivery compared to bed rest (p = 0.001). Women treated with cerclage required a significantly shorter period of antepartum hospitalization (p = 0.001), required less tocolysis (p = 0.005), and experienced fewer preterm membrane ruptures compared to women in the bed rest group (p = 0.01), although the latency period, following preterm rupture of membranes was shorter in the cerclage group (p = 0.005). There was no statistical difference in the frequencies of chorioamnionitis, maternal morbidity and cesarean section between the two groups. Although the perinatal mortality in the two groups was not significantly different (p = 0.3), emergency cerclage resulted in a significantly higher mean birth weight compared to conservative bed rest treatment (p = 0.02). This study demonstrates the superiority of emergency cerclage to bed rest in women with advanced cervical dilatation and absent labor in late second-trimester of pregnancy.