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Emergency cerclageFrom: Kenneth Moise, MD (kmoise@bcm.tmc.edu)Sun Nov 30 17:37:36 1997
Our group has just completed a review of the literature and I thought I would share this with you: There are NO randomized trials reported in the English literture. There are many case series with review articles that claim an overall "success" rate of 50%. The best article is one by Olatunbosun et al. Emergency cerclage compared to bedrest for advanced cervical dilatation in pregnancy. Int Surg 1995;80:170-4. This is a prospective collection of cases performed by a single investigator at three different centers over a 6 year period. All patients were 4 cm or greater in dilatation without evidence of labor. Patients received perioperative indomethacin that was continued for 24 - 48 hours after the procedure. Antibiotics were also given and continued for 5 days post-op. Cerclages were placed within 6 hours of admission; the suture technique is not mentioned. Prolapsing membanes were reduced by pushing then up with an inflated foley or filling the bladder to cause elongation of the cervical canal. Strict bedrest was mandated for 48 hours after the procedure. Results: Emergency Cerclage Bedrest P value Number 22 15 GA at admit 22.4 wks 23.2 wks NS GA at delivery 33.0 wks 28.8 wks 0.001 Chorioamnionitis 9% 13.3% NS PPROM 23% 60% 0.01 Latency period after PPROM 1.6 days 16.4 days 0.005 Birthweight 2.0 kg 1.2 kg 0.02 Neonatal survival 77% 60% NS I understand that the NIH Maternal-Fetal Network may be considering a randomized, multicentered trial to study the issue of emergency cerclage.
-- Kenneth J. Moise, Jr., M.D. Professor, Department of Obstetrics and Gynecology Director, Division of Maternal-Fetal Medicine Baylor College of Medicine Houston, Texas Phone: 713-793-3539 FAX: 713-790-0108 Email: kmoise@bcm.tmc.edu
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