Article information
Summary
We present our experience of cervical cerclage in gestants with a dilated uterine cervix and bulging membranes. Our foetal survival rate is 25%. Transvaginal ultrasound is the technique routinely used to evaluate cervical competence during pregnancy. Vidence exists to confirm that emergency cerclage in cases of advanced dilatation produces a higher level of foetal survival than conservative treatment with bedrest. Controversy persists in those cases where cervical changes have been diagnosed early with ultrasound and in which cervical cerclage has not been demonstrated to be superior to conservative bedrest.
Resumen
Presentamos nuestra experiencia en el cerclaje cervical en gestantes con cérvix uterino dilatado y membranas protruyentes. Nuestra supervivencia fetal es del 25%. La ecografía transvaginal es la técnica aceptada para la valoración de la competencia cervical durante el embarazo. Existe evidencia para afirmar que el cerclaje de urgencia en casos con dilatación avanzada proporciona mayor supervivencia fetal que el tratamiento médico con reposo en cama. Persiste lacontroversia en los casos con cambios cervicales tempranos diagnosticados mediante ecografía, en los que el cerclaje cervical no ha demostrado ser superior al tratamiento conservador en los trabajos realizados.
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Bibliografía
[1.]
Sociedad Española de Ginecología y Obstetricia (SEGO). Protocolo n.o 11: Incompetencia cervical
[2.]
L. Henriet, M. Kaminsky.
Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey.
Br J Obstet Gynaecol, 108 (2001), pp. 1036-1042
[3.]
J.R. Daling, I. Emanuel.
Induced abortion and subsequent outcome of pregnancy.
Lancet, 2 (1995), pp. 170-172
[4.]
K.F. Schultz, D.A. Grimes, W. Cates.
Measures to prevent cervical injury during suction curettage.
Lancet, 1 (1983), pp. 1182-1184
[5.]
MRCOG Working Party on Cervical Cerclage.
Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre trial of cervical cerclage.
Br J Obstet Gynaecol, 100 (1993), pp. 516-523
[6.]
R.W. Rush, S. Isaacs, K. McPherson, L. Jones, I. Chalmers, A. Grant.
A randomised controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery.
Br J Obstet Gynaecol, 91 (1984), pp. 724-730
[7.]
P. Lazar, S. Gueguen, J. Dreyfus, G. Pontonnier, E. Papiernik.
Multicentre trial of cervical cerclage in women at moderate risk of preterm delivery.
Br J Obstet Gynaecol, 91 (1984), pp. 731-735
[8.]
K.M. Groom, A.H. Shennan, P.R. Bennett.
Retrospective study of non-elective cerclage: outcome differs depending on indication and presence of visible membranes at time of cerclage.
J Obstet Gynaecol, 20 (2000), pp. 1
[9.]
D.J. Evans, A.D. Kofinas, K. King.
Intraoperative amniocentesis and indomethacin treatment in the management of an immature pregnancy with completely dilated cervix.
Obstet Gynecol, 79 (1992), pp. 881-883
[10.]
L.J. Scheerer, F. Lang, L. Batolucci, M. Katz.
A new technique for reduction of prolapsed fetal membranes for emergency cervical cerclage.
Obstet Gynecol, 74 (1989), pp. 408-410
[11.]
M. Ogawa, H. Sanada, A. Tsuda, H. Hirano, T. Tanaka.
Modified cervical cerclage in pregnant women with advanced bulging membranes: knee-chest positioning.
Acta Obstet Gynecol Scand, 78 (1999), pp. 779-782
[12.]
I.A. MacDonald.
Cervical cerclage.
Clin Obstet Gynecol, 7 (1980), pp. 461
[13.]
R.C. Goodlin.
Cervical incompetence, hourglass membranes and amniocentesis.
Obstet Gynecol, 54 (1979), pp. 748-750
[14.]
E. Saling.
Prevention of habitual abortion and prematurity by early total occlusion of the external os uteri.
Europ J Obstet Gynec Reprod Biol, 17 (1984), pp. 165-170
[15.]
N. Surico, R. Ribaldone, A. Arnulfo, G. Baj.
Uterine malformations and pregnancy losses: is cervical cerclage effective?.
Clin Exp Obstet Gynecol, 27 (2000), pp. 147-149
[16.]
A. Caruso.
Emergency cerclage in the presence of protruding membranes: is pregnancy outcome predictable?.
Acta Obstet Gynecol Scand, 79 (2000), pp. 265-268
[17.]
J.L. Benifla.
Emergency cervical cerclage after 20 weeks’ gestation: a retrospective study of 6 years’ practice in 34 cases.
Fetal Diagn Ther, 12 (1997), pp. 274-278
[18.]
O.A. Olatunbosum, F. Dick.
Cervical cerclage operation for a dilated cervix.
Obstet Gynecol, 57 (1981), pp. 166-170
[19.]
W.H. Barth, E.R. Yeomans, GDV. Hankins.
Emergent cerclage.
Surg Gynecol Obstet, 170 (1990), pp. 323-326
[20.]
A. Artmann, R. Schuchardt, J. Gnirs, M. Schelling, K.T. Scneider.
Total cervix occlusion-an efficient measure in prolapsed amniotic membranes in extreme prematurity?.
Z Geburtshilfe Neonatol, 205 (2001), pp. 143-146
[21.]
A.G. Mitra, V.L. Katz, WA Jr Bowes, S. Carmichael.
Emergency cerclages: a review of 40 consecutive procedures.
Am J Perinatol, 9 (1992), pp. 142-145
[22.]
S.T. Chasen, N.S. Silverman.
Mid-trimester emergent cerclage: a ten single institution review.
J Perinatol, 18 (1998), pp. 338-342
[23.]
V. Bognoni, A. Quartuccio.
Emergency cerclage and twin pregnancy.
Minerva Ginecol, 49 (1997), pp. 229-234
[24.]
S.J. Schorr, W.J. Morales.
Obstetric management of incompetent cervix and bulging fetal membranes.
J Reprod Med, 41 (1996), pp. 235-238
[25.]
R.C. Goodlin.
Surgical treatment of patients with hour glass shaped or ruptured membranes prior to the twenty-fifth week of gestation.
Sur Gynecol Obstet, 165 (1987), pp. 410-412
[26.]
T.R. Varma, R.H. Patel, V. Pillai.
Ultrasonic assessment of cervix in «at risk» patients.
Acta Obstet Gynecol Scand, 65 (1986), pp. 147-152
[27.]
J. Ludimir, T. Bader, L. Chen, C. Lindenbaum, G. Wong.
Poor perinatal outcome associated with retained cerclage in patients with premature rupture of membranes.
Obstet Gynecol, 84 (1994), pp. 823-826
[28.]
T.F. McElrath, E.R. Norwitz, E.S. Lieberman, L.J. Heffner.
Management of cervical cerclage and preterm premature rupture of the membranes: should the stitch be removed?.
Am J Obstet Gynecol, 183 (2000), pp. 840-846
[29.]
F.J. Zlatnik.
Vaginal ultrasound as and adjunct to cervical digital examination in women at risk of early delivery.
Gynecol Obstet Invest, 51 (2001), pp. 12-16
[30.]
D.R. Guzmán, A.M. Vintzileos, D.A. McLean, M.E. Martins, C.W. Benito, M.L. Hanley.
The natural history of a positive response to transfundal pressure in women at risk for cervical incompetence.
Am J Obstet Gynecol, 176 (1997), pp. 634-638
[31.]
C.A. Sullivan.
Sonographic evaluation of the uterine cervix.
Obstet Gynecol Clin North Am, 25 (1998), pp. 623-637
[32.]
J.D. Iams, F.F. Johnson, J. Sonek, L. Sachs, C. Gebauer, P. Samuels.
Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance.
Am J Obstet Gynecol, 172 (1995), pp. 1097-1106
[33.]
C.V. Smith, J.C. Anderson, A. Matamoros, W.F. Rayburn.
Transvaginal sonography of cervical width and length during pregnancy.
J Ultrasound Med, 11 (1992), pp. 465-467
[34.]
O. Kushnir, D. Vigil, L. Izquierdo, M. Schiff, L. Curet.
Vaginal ultrasonography assessment of cervical length changes during normal pregnancy.
Am J Obstet Gynecol, 162 (1990), pp. 991-993
[35.]
E.F. Funai, M.J. Paidas, A. Rebarber, L. O’Neill, T.J. Rosen, B.K. Young.
Change in cervical length after prophylactic cerclage.
Obstet Gynecol, 104 (1999), pp. 117-119
[36.]
E.R. Guzman, J.K. Forster, A.M. Vintzileos, C.V. Ananth, C. Walters, K. Pregnancy outcomes in women treated with elective versus ultransound-indicated cervical cerclage. Gipson.
Ultrasound Obstet Gynecol, 12 (1998), pp. 323-327
[37.]
E.R. Guzman, C.W. Benito, L. Yeo, A.M. Vintzileos, C. Walters, N. Meirowitz.
Bed rest versus cervical cerclage in the treatment of cervical incompetence manifested by ultrasound around the time of fetal viability.
Am J Obstet Gynecol, 180: pS78 (1999),
[38.]
Althuisius SM, Dekker GA, Hummel P, Bekedam DJ, Van Geijn HP. Final resulst of the Cervical Incompetence Prevention Randomised Trial (CIPRACT): therapeutic cerclage with bed rest versus bed rest alone. Am J Obstet Gynecol 2001;185
[39.]
M.J. Novy, A. Gupta, D.A. Wothe, S. Gupta, K.A. Kennedy, M.G. Gravett.
Cervical cerclage in the second trimester of pregnancy: a historical cohort study.
Am J Obstet Gynecol, 184 (2001), pp. 1477-1486
[40.]
O.A. Rust, O.A. Atlas, K.J. Jones, B.N. Benhan, J. Balducci.
A randomised trial of cerclage versus no cerclage among patients with ultrasonographically detected second-trimestrer preterm dilatation of the internal os.
Am J Obstet Gynecol, 193 (2000), pp. 830-835
[41.]
O.A. Olatunbosum, L. Al-Nuaim, R.W. Turnell.
Emergency cerclage compared with bedrest for advanced cervical dilatation in pregnancy.
Int Surg, 80 (1995), pp. 170-174
[42.]
R. Romero, R. González, W. Sepúlveda, F. Brandt, M. Ramírez, Y. Sorokin, et al.
Infection and labor. VIII. Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance.
Am J Obstet Gynecol, 167 (1992), pp. 1086-1091
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