Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks:

Abstract 

Objective

The objective of the study is to compare outcomes after conservative management alone versus conservative management with cerclage in the treatment of amniotic sac prolapse in the second trimester.

Study design

Retrospective, comparative study at a university hospital/tertiary referral centre. The medical data was provided by the files of 182 women who were in-patients between December 1989 and June 2005 as a result of prolapse of the amniotic sac during live pregnancies between the 17+0 and 26+0 weeks of gestation. The women were assigned to different groups on the basis of the type of treatment received (Group I: operative procedure=emergency cerclage or Group II: conservative procedure=bed rest, tocolysis, administration of antibiotics). Specified level of significance: p<0.05. Main outcome measures: prolongation of pregnancy, pregnancy outcome/infant mortality, and birth weight.

Results

The investigation covered 161 women with amniotic sac prolapse (operative management: n=89, conservative procedure: n=72). With operative procedures it was possible to prolong the pregnancy by 41 days (from the day of admission), compared with 3 days when conservative therapy was used (p<0.001, median values). In the group that received operative treatment, live births occurred in 72% of cases as opposed to 25% of cases in the group of women that received conservative therapy (p<0.001). There was also a significant difference in the median weight at birth of all live-born children: 1340g with operative therapy, 750g by conservative procedures (p<0.001).

Conclusions

In the second trimester operative management of the amniotic sac was associated with improved perinatal outcomes including improved live-born rate, increased birth weight and prolonged pregnancy.

Keywords: Amniotic sac prolapse, Cerclage, Closure of the cervix, Premature birth, Tocolysis