THE EFFECTIVNESS OF EMERGENCY CERVICAL CERCLAGE AND VAGINAL PROGESTERONE IN MANAGEMENT OF SECOND TRIMESTER MISCARRIAGE

Cervical incompetence is an important contributor to pre-term birth and second trimester pregnancy loss. It is defined as the inability to support a full-term pregnancy because of a functional or structural defect of the cervix [1]. The typical symptoms of cervical incompetence include history of recurrent mid-trimester losses or pre-term birth and painless cervical dilatation in the absence of contractions or intrauterine infections. Labor is often short and the premature fetus is born alive. It is reported that the rate of cervical incompetence is between 0.1% and 2%, and is estimated to account for 15% of the recurrent pregnancy losses between 16 and 28 weeks [2]. ,In cases with cervical incompetence, mechanical support of a weak cervix is thought to be the main factor required to prolong the pregnancy. Cervical cerclage has been used to treat cervical incompetence for more than 50 years, since it was first described by Shirodkar [3] and later modified by McDonald [4]. Emergency cervical cerclage has been used as a salvage procedure in women with cervical dilatation and bulging fetal membranes in mid-trimester, in an attempt to prolong the pregnancy to a viable gestation. However, emergency cervical cerclage is likely to increase the risk of infection, due to increased exposure of the fetal membranes to vaginal commensals.Emergency cervical cerclage is effective in prolonging pregnancy and improving neonatal outcome in women with cervical incompetence. It should be considered a viable option for women with a dilated cervix in mid-trimester.