Perinatology.  2019 Dec;30(4):244-248. 10.14734/PN.2019.30.4.244.

Delivery and Survival of Triplet Infants at 26 Weeks of Gestational Age after Emergency Cerclage in Woman with Dilated Cervix and Bulging Fetal Membranes

• Song S
• Park YZ
• Kim EA
• Ham H
• Son G
• Lee KY
• Sung TJ

• KMID: 2468547
• DOI: http://doi.org/10.14734/PN.2019.30.4.244

Abstract

In triplet pregnancy, preterm delivery is a major cause of neonatal morbidity and mortality. If mother was suffering from cervical insufficiency, the effectiveness and safety of cervical cerclage remains controversial. The authors experienced the case of a 29-year-old patient with triplet pregnancy who had dilated cervix and bulging fetal membranes at 20+4 weeks of gestation. The patient underwent emergency cervical cerclage and carried pregnancy until 26th weeks of gestation. The babies were delivered by cesarean section in the 26th week of gestation and they were discharged home at the 40 weeks of corrected age. In triplet gestation as well as single or twin gestation, cervical cerclage in the patients with cervical dilatation and bulging fetal membrane could be successful if obstetricians and neonatologists collaborate.

Keyword

Uterine cervical incompetence; Cervical cerclage; Pregnancy, triplet

MeSH Terms

Adult
Cerclage, Cervical
Cervix Uteri*
Cesarean Section
Emergencies*
Extraembryonic Membranes*
Female
Gestational Age*
Humans
Infant*
Labor Stage, First
Mortality
Mothers
Pregnancy
Pregnancy, Triplet
Triplets*
Twins
Uterine Cervical Incompetence

Reference

References

1. Statistics Korea. Annual report on the vital statistics 2017. [online] 2017 Aug 22 [cited 2019 Feb 28]. Available from: URL:. http://kostat.go.kr/portal/korea/kor_nw/1/2/3/index.board.

2. Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep. 2018; 67:1–55.

3. McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp. 1957; 64:346–50.

4. Aoki S, Ohnuma E, Kurasawa K, Okuda M, Takahashi T, Hirahara F. Emergency cerclage versus expectant management for prolapsed fetal membranes: a retrospective, comparative study. J Obstet Gynaecol Res. 2014; 40:381–6.

5. Young CM, Stanisic T, Wynn LB, Shrivastava VL, Haydon ML, Wing DA. Use of cerclage in triplet pregnancies with an asymptomatic short cervix. J Ultrasound Med. 2014; 33:343–7.

6. Kim SH, Chun J, Ko KH, Sung TJ. Effect of antenatal azithromycin for Ureaplasma spp. on neonatal outcome at ≤30 weeks' gestational age. Pediatr Int. 2018; 61:58–62.

7. Sung TJ, Lee KY, Ju YS. Effects of maternal cervical incompetence on morbidity and mortality of very low birthweight neonates. Neonatology. 2010; 98:164–9.

8. Rafael TJ, Berghella V, Alfirevic Z. Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy. Cochrane Database Syst Rev. 2014; 9:CD009166.

9. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014; 123:372–9.

10. Brown R, Gagnon R, Delisle MF, Maternal Fetal Medicine Committee. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2013; 35:1115–27.

11. Rebarber A, Roman AS, Istwan N, Rhea D, Stanziano G. Prophylactic cerclage in the management of triplet pregnancies. Am J Obstet Gynecol. 2005; 193:1193–6.

12. Rebarber A, Bender S, Silverstein M, Saltzman DH, Klauser CK, Fox NS. Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies. Eur J Obstet Gynecol Reprod Biol. 2014; 173:43–7.

13. Aguilera M, Ramin K, Nguyen R, Giacobbe L, Swartout J. Emergency cerclage placement in multifetal pregnancies with a dilated cervix and exposed membranes: case series. AJP Rep. 2013; 3:1–4.

14. Miller ES, Rajan PV, Grobman WA. Outcomes after physical examination-indicated cerclage in twin gestations. Am J Obstet Gynecol. 2014; 211:46. e1–5.

15. Birenbaum HJ, Dentry A, Cirelli J, Helou S, Pane MA, Starr K, et al. Reduction in the incidence of chronic lung disease in very low birth weight infants: results of a quality improvement process in a tertiary level neonatal intensive care unit. Pediatrics. 2009; 123:44–50.

16. Foglia EE, Jensen EA, Kirpalani H. Delivery room interventions to prevent bronchopulmonary dysplasia in extremely preterm infants. J Perinatol. 2017; 37:1171–9.

17. Soll RF, Morley CJ. Prophylactic versus selective use of surfactant in preventing morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2001; 2:CD000510.

18. Bhandari V. The potential of non-invasive ventilation to decrease BPD. Semin Perinatol. 2013; 37:108–14.

19. Verder H, Robertson B, Greisen G, Ebbesen F, Albertsen P, Lundstr⊘m K, et al. Surfactant therapy and nasal continuous positive airway pressure for newborns with respiratory distress syndrome. Danish-Swedish Mul-ticenter Study Group. N Engl J Med. 1994; 331:1051–5.

20. Kribs A. Minimally invasive surfactant therapy and noninvasive respiratory support. Clin Perinatol. 2016; 43:755–71.