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Abstract
The patient who presents with advanced cervical dilatation and herniating membranes without clear signs of preterm labor prior to the time of fetal viability represents an obstetric dilemma. Nonintervention can be expected to result in inevitable preterm delivery and 20% fetal survival. This study represents the use of a McDonald cerclage in patients with advanced dilatation and herniation of membranes. The study population comprised 14 singleton pregnancies between 17 and 25 weeks gestation at 4 cm dilatation or greater. The operative technique included Foley catheter membrane retraction and McDonald cerclage with 5 mm mersilene tape. Results: The cervix was successfully closed in 13/14 patients (93%). Perioperative complication rate was 21%. Ten of 13 patients in whom the cerclage was successfully placed were delivered of healthy neonates who are alive and well (fetal survival rate 77%). The average duration of pregnancy after successful cerclage placement was 9.3 weeks (range 2 days-17 weeks). Conclusion: In this uncontrolled series a high rate of neonatal survival can be obtained using an aggressive approach combining emergent cerclage and adjunctive medical therapy in patients with advanced dilatation and prolapsed membranes at a previable gestational age.