Emergency cerclage outcomes for bulging fetal membranes: a single-center retrospective study

Purpose This study aimed to investigate the usefulness of emergency cerclage for pregnant women with bulging fetal membranes, as indicated by our original noninvasive clinical scoring system. Methods This was a retrospective study of pregnant women who underwent emergency cerclage for bulging fetal membranes within 28 weeks. The primary outcome was the continuation of pregnancy at 34 gestational weeks in singleton pregnancies and 32 gestational weeks in twin pregnancies. The secondary outcomes were the interval from cerclage to delivery, neonatal mortality, and morbidity. To determine surgical indication, we used the original clinical scoring system comprising cervical shortening or dilation degree and uterine contraction levels. Results 128 women were included in this study (112 singleton pregnancies and 16 twin pregnancies). The continuation of pregnancy rate as the primary outcome (Cerclage Success group) was 78.6% in singleton pregnancies and 75% in twin pregnancies. The median interval between cerclage and delivery was 94 days in singleton pregnancies and 78 days in twin pregnancies. Approximately 85% of the babies weighed >= 1500 g at birth. Neonatal mortality occurred in only one case, and nine singletons in the Cerclage Failure group had severe neonatal morbidities. According to multivariate analysis of prognostic factors in the Cerclage Failure group, only the serum C-reactive protein level at 1 week postoperatively was an independent prognostic factor (odds ratio: 9.75; 95% confidence interval: 2.99-31.8; p < 0.01). Conclusion Emergency cerclage, performed under the indications of our original noninvasive clinical scoring system, led to favorable outcomes.