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‘Rescue’ cerclage after bulging membranes at 22 weeks: delaying the inevitable? 

‘Rescue’ cerclage after bulging membranes at 22 weeks: delaying the inevitable?
Chapter:
‘Rescue’ cerclage after bulging membranes at 22 weeks: delaying the inevitable?
Author(s):

Natasha Hezelgrave

DOI:
10.1093/med/9780199654994.003.0008
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date: 22 August 2019

This case describes a case of cervical shortening (and resultant fetal bulging membranes) in a pregnancy following a cervical large loop excision of the transformation zone (LLETZ). Whilst there is a strong evidence base behind the use of cervical cerclage in the presence of a short cervix with a history of previous premature birth, the use of rescue cerclage once bulging membranes have been diagnosed is controversial. Whilst it has been shown to prolong pregnancy in small studies, there is concern as to whether this translates into improved fetal outcome. In particular, whether the insertion of a rescue suture may result in the survival of a more damaged baby, either by virtue of lower gestational age (intervention further stimulating the inflammatory process), or by the increased risk of chorioamnionitis and neonatal sepsis. This case reviews the evidence base behind investigations and interventions to predict and to prevent prematurity, and benefits from expert neonatology input.

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