A Novel Double Cerclage Technique for Emergency Cerclage in Women at High Risk for Preterm Birth

INTRODUCTION: We report on a series of emergency and reinforcing cerclages using a novel double cerclage technique. METHODS: A 5-year prospective cohort study was conducted on pregnant women with cervical insufficiency managed with our novel double cerclage technique. Eligible patients with cervical dilation of 1–4 cm before 24 weeks of gestation and patients with a failed primary cerclage in situ were included and offered repeat reinforcing cerclage. Patients in preterm labor and intraamniotic infection were excluded. Our technique includes an emergency McDonald cerclage using Mersilene followed by a distal cervical occlusion stitch with Prolene passed through the full thickness of the cervix from anterior to posterior in a running mattress fashion. The primary outcome measured was delivery after 28 weeks of gestation. Included is a subgroup analysis based on cervical dilation at presentation. Secondary outcomes measured included preterm premature rupture of membranes and maternal sepsis presenting within 2 weeks of cerclage placement. RESULTS: Fifty-three patients met these criteria and underwent emergency cerclage, 17 of which were reinforcing cerclages. Overall, 74% delivered after 28 weeks of gestation, 7.5% had preterm premature rupture of membranes, and there were no cases of maternal sepsis. Delivery after 28 weeks of gestation was achieved in 89% of those in the 1- to 2-cm group, 41% in the 2- to 4-cm group, and 56% in the reinforcing cerclage group. CONCLUSION: The novel double cerclage technique for emergency or reinforcing cerclage has a promising success rate and could represent an improvement over standard techniques.