Emergent and elective cervical cerclage for cervical incompetence

Objective: The clinical outcomes of emergent and elective McDonald cerclage including cases of prolapsed amniotic sac were compared. Method: Forty-eight patients undergoing elective cervical cerclage suture and 21 patients receiving emergent cervical cerclage including eight cases of prolapsed fetal membranes in the vagina were retrospectively analyzed. Results: Prolongation of pregnancy (145 ± 27 vs. 58 ± 56 days, P < 0.001), delay of delivery (37.0 ± 3.1 vs. 28.3 ± 7.8 gestational weeks, P < 0.001), higher birth weight (3033 ± 751 vs. 1410 ± 1139 g, P = 0.001), better fetal salvage rate (98 vs. 52%, P < 0.05), and fewer lower Apgar scores (score < 7: 4/48 vs. 13/21 at 1 min, P = 0.000; 2/48 vs. 10/21 at 5 min, P = 0.000) were attained in the elective group compared with those in the emergent group. The clinical outcomes were not significantly different between those with and those without prolapsed fetal membranes, but this may have been due to the small sample size. Conclusion: In addition to elective cervical cerclage, we recommended this procedure in emergency cases even in those with a prolapsed amniotic sac.