I had just lost a twin pregnancy some months back, I am really upset because I felt that my pregnancy was not properly managed. Couldn’t an emergency cerclage be of help?

 

Question:  I had just lost a twin pregnancy some months back. I visited the hospital severally for antenatal care; I have had episode of bleeding and on one of the visits to the hospital to make a complaint, the doctor I met said that I had an open cervix and bulging membranes after conducting an examination. What was depressing was that I had done an anomaly scan just 2 days before then. I am really upset because I felt that my pregnancy was not properly managed. Couldn’t an emergency cerclage be of help?

Doctors Response: When a patient  with an open cervical os and bulging membranes presents before viability, the idea of closing the cervix by passing a stitch around it seems logical. However, the results of emergency cervical cerclage are poor and are related to the cervical dilatation at insertion.




The procedure itself can be technically challenging. A dilatation of more than 3cm with an effaced cervix poses extreme difficulties, even for the most experienced operator. If persistent placental bleeding is leading to secondary opening of the cervix, suturing the cervix clearly does not address the primary issue and is unlikely to be successful. Bleeding, contractions and infection are all contraindications to cerclage. Depending on the initial dilatation of the cervix, the chance of the pregnancy proceeding beyond 26 weeks may be less than 50%.



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