Emergency cervical suture: the obstetrician's dilemma.

We studied the perinatal mortality and morbidity associated with emergency cervical suture at Royal North Shore Hospital over 7 years. There were 23 patients who had an emergency cervical suture inserted and they were divided into 3 groups for analysis, Group 1: patients with cervical dilatation initially detected on routine 18-20 week ultrasonography and later confirmed on clinical examination, Group 2: cervical dilatation < or = 3 cm and Group 3: cervical dilatation >3 cm at presentation. The median delay in delivery in each group was 6, 5 and 3 weeks respectively. The perioperative membrane rupture rate for emergency suture insertion in this study was 13%. The perinatal mortality rate for each group was 0%, 33% and 43% respectively with an overall rate of 33%. Follow-up at 3-5 years of 9 babies with a birth-weight < or = 1,000 g, revealed that of 6 survivors, 1 had moderate disability and 2 had mild disability. No survivors had severe disability. From the results of our study, emergency cervical suture can prolong gestation and in the absence of prolapsed fetal membranes, the perioperative membrane rupture rate is low. However, it is important to consider that the time gained from emergency cervical suture insertion may convert a previable fetus into an extremely premature infant with the risk of long-term disability.