Background: We tried to evaluate, whether emergency operative closure of the cervix (EOCC) is a realistic option for prolongation of pregnancy in cases with early opening of the cervix and prolapse of the amniotic sac (PAS) into the vagina.
Patients and methods: We report on 16 patients with PAS between 15 + 3 and 28 + 1 weeks of gestation and cervix dilatation between 2 and 8 cm. After antibiotic and tocolytic treatment we performed EOCC in 7 cases and EOCC + Cerclage in 9 cases. Pregnancy follow up and fetal outcome were analysed retrospectively.
Results: Mean gestational age at delivery was 33 + 1 weeks (9 cases > 32 + 0 weeks, 2 cases between 28 + 0 and 31 + 6 weeks, 3 cases between 25 + 0 and 27 + 6 weeks, 1 case with rupture of membranes during operation and immediate cesarean section at 28 + 1 weeks, 1 miscarriage at 23 + 3 weeks). Time between EOCC and delivery was between 0 and 146 days (mean 56.3 days), 14 fetuses survived healthy. The best results were obtained after EOCC + cerclage.
Conclusion: If antibiotic and tocolytic treatment was successful in stopping local infection and contractions, EOCC is an acceptable and mostly successful procedure to prolong pregnancy.