Recent Management of Cervical incompetence / 대한산부인과학회지

Treatment of incompetent cervix has traditionally been surgical correction of presumed physical deficit in tissue strength with an encircling or cerclage suture, placed electively between 12 and 15 weeks or urgently in the second trimester. Despite the prolonged controversy about the role of cerclage, a randomized trial of cerclage versus bed rest or no therapy in women with atypical history of incompetent cervix has not been concluded. Until conclusive information is available, clinicians challenged to make the best management decision or each patient based on her history and cervical examination. Women with either a typical history of recurrent midtrimester delivery in the absence of another diagnosis or with atypical history accompanied by significant cervical effacement should be offered treatment with cerclage accompanied by an acknowledgement that it's efficacy is unproven. A cerclage operation may be considered during pregnancy in four clinical setting which is elective cerclage, urgent cerclage, emergency cerclage, transabdominal cerclage.

Clinical efficacy of urgent cerclage in cervical incompetence predicted by transvaginal ultrasonography in second trimester / 대한산부인과학회잡지

OBJECTIVE: To investigate the clinical efficacy of urgent cerclage on perinatal outcome in cervical incompetence predicted by transvaginal ultrasonography in second trimester. METHODS: We reviewed the medical records of 27 pregnant women who received urgent cerclage at Asan Medical Center between January, 1998 and August, 2002. When the cervical length was less than 25 mm and abnormal cervical shape by transvaginal ultrasonography in second trimester, we performed urgent cerclage. Abnormal cervical shapes were categorized as U-shape, Y-shape and V-shape. These data were compared with those of 102 patients who received prophylactic cerclage and 25 patients who received emergent cerclage during the same period. Analysis of variance and chi-square test were used for statistical analysis. P<0.05 was considered statistically significant. RESULTS: In urgent cerclage, the mean gestational age at delivery was 35.1 +/- 4.4 weeks. The mean birth weight was 2524.2 +/- 860.8 gm and perinatal survival rate was 92.6% (25/27). We compared these data with the other two cerclages. In prophylactic cerclage, the mean gestational age at delivery was 36.2 +/- 4.6 weeks. The mean birth weight was 2711.5 +/- 860.8 gm and perinatal survival rate was 94.1% (96/102). There was no statistically significant difference between urgent cerclage and prophylactic cerclage. In emergent cerclage, the mean gestational age at delivery was 27.5 +/- 6.9 weeks. The mean birth weight was 1373.8 +/- 1196.7 gm and perinatal survival rate was 48.0% (12/25). There was statistically significant difference between urgent cerclage and emergent cerclage based on our finding, The gestational age, birth weight and perinatal survival rate in urgent cerclage were not different from prophylactic cerclage. However, in emergent cerclage, these data were different from the other two cerclages. CONCLUSION: These data suggest that perinatal outcomes after urgent cerclage were comparable to those of prophylactic cerclage. Urgent cerclage could be a valuable alternative to a policy of uniform prophylactic cerclage.