Özet:

To compare perinatal outcomes of prophylactic cerclage and emergency cerclage operations in patients with cervical insufficiency to prevent premature birth. METHODS: A retrospective study was conducted between June 2009 and June 2019 at the University of Bulent Ecevit, Department of Obstetrics and Gynecology. All medical records were evaluated. Patients with history of one or more second trimester pregnancy losses related to painless cervical dilation and in the absence of labor or abruptio placentae or history of prior cerclage due to painless cervical dilation in the second trimester were included to prophylactic cerclage group and patients with painless cervical dilation and/or prolabed membranes at physical examination in the second trimester were included to emergency cerclage group. Pregnancy complications, perinatal outcomes and inflammatory markers such as WBC count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR) were assessed. Results: Live birth rate was 96.6% in the prophylactic cerclage group which was consisted of 27 patients and 81.3% in the emergency cerclage group which was consisted of 16 patients. Similarity was observed in comparison of live birth rate, gestational age at birth, preterm birth rates and birthweight between both groups (p=0,137; p=0,179; p=0,085; p=0,602). Cervical dilatation was between 1 and 4 cm in emergency cerclage group. Cervical dilatation was ≥3 cm and membranes were prolabed in 5 patients. Only one of the five patients' pregnancy was resulted with term birth. WBC count were higher in emergency cerclage group than prophylactic cerclage group (p=0,037). On the contrary, no difference was seen in comparison of NLR, PLR, neutrophil, lymphocyte, and platelet count between groups. Likewise, WBC, NLR and PLR were not different between the patients who were delivered preterm and term in all groups. DISCUSSION AND CONCLUSION: Our study suggests that both prophylactic cerclage and emergency cerclage increase the live birth and term birth rates. However increased neonatal mortality, abortion and premature membrane rupture rates were observed in patients with cervical dilatation ≥3 cm. Patients must be carefully evaluated before emergency cerclage surgery.

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