Successful Delivery Outcome after Cervical Cerclage on Cervical Insufficiency with PPROM in Limited Resource Setting: A Case Report

Objective: To report the Successful Delivery Outcome After Cervical Cerclage On Cervical Insufficiency With PPROM In Limited Resource Setting Methods: Reporting Successful Delivery Outcome After Cervical Cerclage On Cervical Insufficiency With PPROM In Limited Resource Setting Result: A 43 year-old woman admitted to Arifin Achmad Regional Hospital with PRROM on G6P5A0 1 live child with previous C-section one times, singleton live intrauterine fetus and bad obstetric history on December 2016. On history taking, we noted a past history of 5 times preterm labor, with 4 times of second trimester pregnancy losses. On physical examination found pooling of fluid that confirmed with nitrazine paper test, the external uterine osteum was closed. An abdominal ultrasonography evaluated correspond to 26-27 wga singleton live intrauterine fetus with the cervical length was 5, 8 mm, single pocket AFI was 3, 8. Patient met the diagnostic criteria of history indicated cerclage with sign and symptom of proceeding infection could be rule out. Elective cerclage with Mc Donalds technique was performed. Patient was received ceftriaxone and 3 type of tocolytics (Isoxsuprine Hydrochloride, ketoprofen and nifedipine) for 3 days. Patient was treated as outpatient clinic for two months with recommendation of bed rest, rehydration two litres of fluids per day, abstinence sexual intercourse, serial US examination and vaginal toilet. Patient was scheduled for elective caesarean section at 36 wga. The cerclage was removed first then followed by delivery of the baby. Discussion: Cerclage in PPROM did not signicantly prolong the gestational latency period. it did not signicantly increase the rates of neonatal sepsis, or the neonatal death rates. Maternal chorioamnionitis was signicantly more prevalent among women offered cerclage retention. Our consideration when we did the cerclage and retain the cerclage although the patient already in PPROM condition that there was no sign of infection, chorioamnionitis, preterm labor and fetal distress from the clinical, laboratory result, serial ultrasound before and after we did the cerclage.4 Conclusion: Cerclage in PPROM remains a matter of debate and controversial case. The current recommendation is individualized management that weighs the risks of prematurity and infection.