Effectiveness of emergency cerclage in cervical insufficiency

TLDR

The study aimed to evaluate whether emergency cerclage improves obstetric and neonatal outcomes compared to conservative management in women with clinically evident cervical insufficiency. A retrospective cohort of women with cervical insufficiency diagnosed between 14 and 24 weeks was analyzed, comparing those who received emergency cerclage to those who chose conservative therapy. Emergency cerclage was associated with longer gestation, later delivery, and higher term birth rates, especially when cervical dilatation was below 5 cm, whereas outcomes were similar to conservative management when dilatation exceeded 5 cm, with no difference in mode of delivery.

Abstract

Objective: To assess the effectiveness of emergency cerclage versus conservative management in improving obstetric and neonatal outcomes in women with clinically evident cervical insufficiency.Methods: Retrospective cohort study conducted on all women with a single viable pregnancy diagnosed with cervical insufficiency between the 14th and 24th gestational week without pPROM, clinical chorioamnionitis, vaginal bleeding, treatment-resistant uterine contractions or life-incompatible fetal anomalies, from January 2009 to December 2014. Obstetric and neonatal outcomes were compared between women who underwent cerclage and those who refused, preferring a conservative therapy.Results: Eighteen women underwent emergency cerclage and 19 were managed with a conservative therapy. Mean gestational age at delivery, time from diagnosis to delivery and rate of term birth were significantly higher in the first cohort. Those variables show a linear inverse correlation with the degree of cervical dilatation, with better outcomes in patients who underwent cerclage with a dilatation lower than 5.0 cm. No difference in mode of delivery were found.Conclusion: Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm.