Rescue cerclage

Abstract

OBJECTIVE: Evaluation of outcomes of rescue cerclage at our institution. METHODS: A retrospective study of women who received rescue McDonald cerclage, from January 2002 to December 2004, at Inova Fairfax Hospital. Rescue cerclage is defined as cervical dilation of 1.5 cm or more by digital examination and membranes visible or prolapsed through the cervical canal. Outcomes assessed are prolongation of pregnancy in weeks, mean gestational age at delivery, proportion of women reaching 28, 32, and 34 weeks, neonatal survival rate, and mean birth weight. RESULTS: A total of 55 women met the inclusion criteria. Timing of cerclage placement ranged from 17 to 27 weeks. The mean prolongation of pregnancy was 12.0 ± 6.4 weeks (0.6–26 weeks). The mean gestational age at delivery was 32.3 ± 6.5 weeks (18.6–40.9 weeks). Percentages of patients reaching 28, 32, and 34 weeks were 69%, 61%, and 54%, respectively. The survival rate of the 43 infants reaching viability was 98%. Mean birth weight was 2,548 ± 930 g (430–4,420 g). Women who required rescue cerclage after failed prophylactic cerclage (n = 12) were 50% less likely to reach 28 weeks. Advanced dilation of 3 cm and/or prolapsed membranes (n = 18) did not decrease the likelihood of reaching 28 weeks. Mean gestational age at delivery for this subset of patients was 30.7 ± 7.2 weeks. CONCLUSION: In contrast to previously reported series, our results show that rescue cerclage can result in significant pregnancy prolongation. Outcomes are not as grim as prior literature suggests, and we strongly support the consideration of rescue cerclage for these patients.