P01.04: Emergency cerclage: evaluation of its efficacy and identification of prognostic factors

To evaluate the efficacy of emergency cerclage and identify clinical variables that may have an impact on pregnancy outcome. Retrospective study (2003–2013) of women with singleton pregnancies who underwent emergency cervical cerclage between 15 and 24 weeks of gestation. An emergency cerclage was defined as a cerclage placement in women with a cervical length of less than 15 mm and/or cervical dilation greater than or equal to 1 cm at time of procedure. Subjects were divided into groups depending on gestational age at delivery for comparison of variables. 88 women were identified and 2 were excluded from statistical analysis due to amniotic membrane rupture at the time of cerclage. The mean gestational age at the time of cerclage was 20.5 weeks. The mean cerclage-delivery interval was 72 days. The mean gestation at delivery was 31 weeks. 76 percent of women delivered after 24 weeks, 65% delivered after 28 weeks and 49% delivered after 34 weeks. The mean cervical length at time of cerclage was 7.5 mm and the mean cervical dilation was 1.7 cm. A cervical length < 5 mm prior to the cerclage predicted a delivery before 34 weeks (p = 0.001) whereas a cervical length < 10 or even 15 mm did not predict delivery before 34 weeks. An ultrasound indicated cerclage defined as women with no cervical dilation at time of cerclage predicted delivery after 34 weeks (p = 0.001). The prolapse of amniotic membranes in the vagina predicted a delivery before 28 weeks gestation whereas prolapse at the cervical os predicted a delivery before 34 weeks (p = 0.001). The presence of sludge did not predict preterm delivery. It is known that emergency cerclage can prolong pregnancy and delay delivery in women presenting cervical incompetence. In the last ten years, we have identified 88 emergency cerclage in our centre and the average time gained after an emergency cerclage was 10 weeks. Some variables were associated with a shorter cerclage-delivery interval such as amniotic membranes prolapse, cervical dilatation > 2 cm and cervical length < 5 mm.