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Non-invasive emergent cerclage using a plastic sling: case series
  1. Humberto Azpurua1,
  2. Otto Paredes2,
  3. Solanye Navas3,
  4. Jose Moros4
  1. 1Maternal Fetal Medicine, Centro Materno Fetal Santa Paula Av, Caracas, Venezuela
  2. 2Department of Reproductive Sciences, CREAFAM, Puebla, Mexico
  3. 3Department of Obstetrics and Gynaecology, Hospital Quiron, Murcia, Spain
  4. 4Department of Obstetrics and Gynaecology, Centro Medico La Paz, Bata, Equatorial Guinea
  1. Correspondence to Dr Humberto Azpurua, Maternal Fetal Medicine, Centro Materno Fetal Santa Paula Av, Circunvalación del Sol, Urb Santa Paula Caracas, 1059, Venezuela; humberto.azpurua{at}gmail.com

Abstract

Cervical incompetence represents a controversial problem for the modern obstetrician. Treatment modalities since its description have changed with time. Shirodkar and McDonald cerclage techniques have remained the mainstay in the treatment of women with incompetent cervices performed either electively or emergently. The most feared complication of an emergency cervical cerclage is the rupture of membranes during the procedure, especially when the cervix is wide open and the membranes are protruding. To decrease that complication, some methods to reduce the prolapsed membranes have been used: filling the bladder with 0.45% saline solution through a Foley catheter, performing an amniocentesis to decrease intra-amniotic pressure and subsequent reduction of the prolapsed membranes as well as the use of balloons to push the membranes back into the uterus before the placement of a suture. Nevertheless, the introduction of such a sharp instrument like a needle in order to place the suture is a very risky step. Lately, a silicone pessary has also been used to perform cerclages but with disparate results. We present the successful use of an innovative method in 3 patients with cervical incompetence who presented with pregnancies <24 weeks and cervical effacement with protruding membranes into the vagina.

  • cerclage
  • cervical incompetence
  • preterm birth
  • Plastic sling
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Footnotes

  • Twitter Follow Jose Moros @JEMOROS and Humberto Azpurua is @azpuruaMD

  • Competing interests None declared.

  • Ethics approval Bioethics committee of Hospital Universitario de Caracas.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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