Is there still a role for emergency cerclage in the developed world? An experience from a London district hospital

By:

Steel, A

Contributor(s):

Publication details: 2008ISSN:

09320067

Uniform titles:

Archives of Gynecology and Obstetrics

Online resources:

Summary: INTRODUCTION: Cervical incompetence appears to have a greater prevalence in the developing world, which possibly extends to multi-ethnic communities in the UK. Emergency cerclage has been found to have a relative degree of success in patients detected on ultrasound or presenting clinically. Our study aimed to look at the emergency cerclage outcome in the multi-ethnic population of our district hospital.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">METHODS:</h4>Sixty-two cases of cervical cerclage were reviewed retrospectively from 2000 to 2006 with 16 cases being emergencies. Maternal history, presentation, operation details and outcome were recorded.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">RESULTS:</h4>Of the 16 emergency cases, 8 were successful (delivery over 24 weeks gestation), 7 failed and 1 had not yet delivered. The failure rate was found to be significantly higher in the black African women (P = 0.04). Diagnosis by ultrasound as opposed to clinical presentation was associated with a better outcome (P = 0.03). The most significant determinant of outcome was the presence of coliforms on presentation, all of which failed (P = 0.007).<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">CONCLUSION:</h4>In this small sample of patients requiring emergency cerclage, findings are suggestive of a poor outcome in black African women, which may be related to previous obstetric history. Similarly the presence of infection especially coliforms is also associated with poor prognosis, while ultrasound diagnosis of dilating cervix rather than clinical diagnosis had a better outcome. Early screening for infection, use of prophylactic antibiotics and sonographic monitoring are likely to improve the success rate of emergency cervical cerclage.

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Item type	Home library	Collection	Class number	Status	Date due	Barcode
UNKNOWN	Ferriman Information and Library Service (North Middlesex) Online	Staff publications for NMDX		Available

NMUH Staff Publications

277

INTRODUCTION: Cervical incompetence appears to have a greater prevalence in the developing&nbsp;world, which possibly extends to multi-ethnic communities in the UK.&nbsp;Emergency&nbsp;cerclage&nbsp;has been found to have a relative degree of success in patients detected on ultrasound or presenting clinically. Our study aimed to look at the&nbsp;emergency&nbsp;cerclage&nbsp;outcome in the multi-ethnic population of our&nbsp;district&nbsp;hospital.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">METHODS:</h4>Sixty-two cases of cervical&nbsp;cerclage&nbsp;were reviewed retrospectively from 2000 to 2006 with 16 cases being emergencies. Maternal history, presentation, operation details and outcome were recorded.<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">RESULTS:</h4>Of the 16&nbsp;emergency&nbsp;cases, 8 were successful (delivery over 24 weeks gestation), 7 failed and 1 had not yet delivered. The failure rate was found to be significantly higher in the black African women (P = 0.04). Diagnosis by ultrasound as opposed to clinical presentation was associated with a better outcome (P = 0.03). The most significant determinant of outcome was the presence of coliforms on presentation, all of which failed (P = 0.007).<h4 style="margin: 0px 0.25em 0px 0px; text-transform: uppercase; float: left; line-height: 17.999801635742188px;">CONCLUSION:</h4>In this small sample of patients requiring&nbsp;emergency&nbsp;cerclage, findings are suggestive of a poor outcome in black African women, which may be related to previous obstetric history. Similarly the presence of infection especially coliforms is also associated with poor prognosis, while ultrasound diagnosis of dilating cervix rather than clinical diagnosis had a better outcome. Early screening for infection, use of prophylactic antibiotics and sonographic monitoring are likely to improve the success rate of&nbsp;emergency&nbsp;cervical&nbsp;cerclage.

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