Poster Session

P205. Cervical cerclage of rescue in the management of cervical incompetence. Experience of luis tisne brousee hospital

Andrea Sepulveda (CL), Alejandra Catalán (CL), Beatriz Guendelman (CL), Patricio Narvaez (CL), Jose Lattus (CL)

[Sepulveda] Hospital Luis Tisne, [Catalán ] Hospital Luis Tisne, [Guendelman] Hospital Luis Tisne, [Narvaez] Hospital Luis Tisne, [Lattus] Hospital Luis Tisne

Introduction: Cervical cerclage is surgery that corrects cervical incompetence. The prophylactic cerclage, which is performed between 12 and 14 weeks of gestation, indicated when there is a history of cervical incompetence; the therapeutic cerclage that is made after the detection of changes in the cervix before 24 gestation weeks, with a risk preterm delivery potential; and salvage or emergency cerclage is performed in patients who present exposure of visible amniotic membranes through the external cervical os or in the vagina. Objectives: Management and perinatal outcomes in whom a cervical rescue cerclage was indicated in our hospital, from January 2013 to January 2017. Material and method: Retrospective and descriptive study. The number of patients admitted to the operating room and the proceudure was registered. Clinical history was reviewed from the medical records. Results: 32 cases of rescue cerclage were analyzed. Epidemiological and obstetric history were recorded. The average age of the patients was 29 years (range 19-43 years), previous abortion was presented by 12 patients (38%), preterm birth before was presented by 7 patients (22%). The mean gestational age at the time of cerclage was 22 + 2 weeks with a range between 16 and 26 weeks. Cervicometry was performed on all patients, excluding those in which there was a frank exposure of membranes. The average of the cervicometry was 6 mm, with a range between 0 and 21 mm, 20 patients (63%) showed membrane exposure. Prior to the procedure, vaginal cultures were requested. It is noteworthy that 60% of the patients had development of Ureaplasma parvum (20 patients), 1 patient presented development of mycoplasma hominis concomitant to ureaplasma development. The average gestational age at birth was 32 weeks with a range between 17 to 40 gestation weeks. 72% exceeded 28 weeks. Of the group of patients who exceeded 28 weeks, 31% (10 patients) had a delivery between 28 + 0 weeks and 34 + 0 weeks. 41% (13 patients) had a delivery after 34 + 1 gestation weeks. The delivery route was vaginal in 19 patients (59%), cesarean in 9 patients (28%) and forceps in 4 patients (13%). Conclusion: With our casuistry, it has been possible to unify the management of both the surgical technique and the follow-up, so that in front of a patient in the second trimester with a clear cervical incompetence, the rescue cerclage seems to be the intervention that can change the fetal prognosis.