ACTA FAC MED NAISS 2008; 25 (1): 55-58

Case report

AMNIOREDUCTION AND EMERGENCY CERCLAGE WITH BULGING MEMBRANES

Milan Stefanovic

Predrag Vukomanovic

Ranko Kutlesic, Marija Tasic

Aleksandra Tubic – Pavlovic

Clinic of Gynecology and Obsetrics, Clinical Center Nis

SUMMARY

Emergency cerclage in the second trimester is a recognized treatment for a dilated cervix. In cases with advanced cervical dilatation and bulging membranes, it has been referred to as “heroic cerclage” due to its poor success rate.

We report a case of a successful cerclage performed in a 25-year-old woman in her second pregnancy. On admission, cervical dilatation was 4 cm and membranes were bulging. There were no clinical and laboratory signs of infection. Although the cervical cerclage in advanced cervical dilatation with bulging membranes is controversial, we suggest and perform the “heroic“cerclage with amnioreduction at the same time. The postoperative course with intensive intravenous tocolysis and broad-spectrum antibiotics were without complications and she was dismissed in the 24th week of pregnancy.

The need for cerclage in the second trimester of pregnancy is not rare. According to our experience, we advise cervical cerclage with amnioreduction in pregnant women with advanced dilatation and bulging membranes in the second trimester.

Despite generally bad prognosis, successful outcome is not impossible, along with adequate antibiotic therapy, intensive tocolysis and bed rest. Postoperative transvaginal ultrasound cervical examination is likely to be helpful in prognosis of the pregnancy outcome.

            Key words: cerclage, amniocentesis, amnioreduction, miscarriage