Rescue cervical cerclage with natural Progesterone supplementation: A personal experience with five cases

What is it about?

In this study, I share my experience with five patients presenting with an open cervix (neck of the womb) and bulging foetal membranes into the vagina. My five patients were managed with a rescue cervical cerclage; that is, with putting, under anaesthesia, a stitch around the cervix to strengthen it, after pushing the bulging membranes inside the uterine cavity. Patients presented at around 19-20 weeks of gestation. They were all managed with the cervical stitch and natural vaginal progesterone pills. All the pregnancies were prolonged to foetal survivability, which is set at around 24 weeks of gestation. Patients delivered their babies on average around 35 weeks of gestation. The take-home baby rate was 80 % (4/5). Sadly, there was one intrauterine foetal loss at 34 weeks of gestation due to an unrecognised premature rupture of foetal membranes with ensuing infection.

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Why is it important?

Many clinicians may hesitate to offer this pregnancy-saving procedure and may consider it futile to operate on such patients, with advanced cervical dilatation and exposure of foetal membranes. This small study, like many other similar studies, is very encouraging. It is worthwhile to recommend a rescue cervical cerclage ( emergency cervical stitch) to all patients presenting with this condition, provided that there are no obvious contraindications, like active labour, active bleeding, obvious infection, and in the absence of a foetal malformation incompatible with life. Patients with this condition remain at high risk and will need to have ongoing specialist care.

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