الفهرس 
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Abstract
This prospective comparative study was conducted to compare the outcome of emergency cerclage versus conservative management in prevention of preterm labor in Minia University Maternity Hospital during the period from March 2021 to December 2023.
Eighty patients with painless cervical dilatation in the second trimester were recruited into this study. After clinical assessment, inclusions and exclusions criteria were applied, the recruited patients were allocated into two equal groups, each containing 40 patients.
group I (40): (emergency cerclage group)
group II (40): (conservative group)
The recruited patients in both groups were subjected to history taking, clinical examination, laboratory evaluation, abdominal and trans vaginal ultrasound, preoperative medical evaluation, anesthetic risk assessment and a written informed consent was obtained.
A thorough counseling about the clinical condition, the suggested plan of management, possible complication and need for post operative follow up were explained to the patients.
Emergency cerclage procedure was done by experienced team. After the procedure patients were transefered to the regular ward for observation up to discharge in stable condition . patients who develop intraoperative ROM the procedure cancelled and left for spontaneous explusion of the baby.
Follow up an appointement for patients with emergency cerclage were given in the out-patient depatement (OPD). During this appointement, abdominal ultrasound was done to detect fetal viability and exclusion of any sign of infection or complication.
The following operative and post operative data were collected
.Operative time
.Type of anesthesia
.Any intraoperative complication e.g ROM, vaginal bleeding
.Any post operative complication e.g ROM, chorioamnionitis
The present study report that:
(1). The difference between the two groups regarding different demographic data was not statistically significant
(2). The difference between the two groups regarding different clinical data was not statistically significant. The commonest gestation age at time of presentation was around 20 week. The commonest medical comorbidities were anemia and gestational diabetes.
(3). The difference between the two groups regarding cervical diltation was statistically significant. Cervix was dilated about 3 cm in the majority of patients in both groups.
The difference between the two groups regarding the level of membrane was statistically significant. Most of patients presented with membrane above or at the level of the cervix in group I.
(4). Operative finding in emergency cerclage group were reported in terms of.
The mean of operative time was about 18 minutes.
The majority of cases done under spinal anesthesia.
Ballon of foleys catheter was used in all patients with bulging membrane below the level of the cervix to reduce the membrane.
Regarding the three patients with accidently rupture of membrane , it happened in the theatre just after positioning and before giving anesthesia so the procedure was cancelled.
(5). The difference between the two groups regarding the latency period and gestational age at time of delivery was statistically significant.
The commonest gestational age reached in cerclage group range from 28 to 32 weeks.
(6). The difference between the two groups regarding different perinatal outcome variables were statistically significant except the mode of delivery.
The mean gestational age at time of delivery was about 27 weeks.
The common mode of delivery was normal delivery. the indication for CS was breech preterm in labor
The mean neonatal birth weight in group one was about 1341.6 gm.
The commonest indication for admission in NICU were low birth weight and RDS.
Neonatal death was more reported in patients managed conservatively.
(7). Perinatal outcome according to the level of membrane in relation to the cervix in emergency cerclage group were statistically significant.
Neonatal death in all patients presented with membrane below the cervix
(8). Perinatal outcome according to cervical dilatation in emergency cerclage group were statistically significant.
Neonatal death occur in majority of cases presented with cervical dilatation about 4 cm.
(9). Complications reported in patients subjected to emergency cervical cerclage were reported in terms of :
No anesthesia complications occurred in patients.
Regarding the three patients with accidently rupture of membrane , it happened in the theatre just after positioning and before giving anesthesia so the procedure was cancelled.
Infections occurred in six patients.
Miscarriage occurred in eight patients.
(10). The difference between the two groups regarding hospital stay were statistically significant. Hospital stay was prolonged in conservative group.