[Aggressive management of prolapsed fetal membranes earlier than 26 weeks' gestation by emergent McDonald cerclage combined with amniocentesis and bladder overfilling].

During the period January, 1987-December, 1992, 32 pregnant women (33 fetuses) earlier than 26 weeks' gestation were admitted to our perinatal unit with incompetent cervix and prolapsed fetal membranes through the cervix (hourglassing). Eighteen pregnant women (19 fetuses) were managed aggressively with emergent double McDonald cerclage, which included preoperative amniocentesis and bladder overfilling to decompress and replace prolapsed fetal membranes. Fourteen pregnant women were managed conservatively with bed rest, tocolysis, and antibiotic therapy. The perinatal results of aggressive management were clearly more favorable than those of conservative management when compared: Prolongation of pregnancy 35.2 +/- 39.7 vs. 3.5 +/- 2.6 days (p < 0.01), gestational age at delivery 27.3 +/- 5.3 vs. 24.2 +/- 1.2 weeks' (p < 0.05), birth weight 1,260 +/- 909 vs. 690 +/- 124 grams (p < 0.05), and fetal salvage rates 74(14/19) vs. 7(1/14)%, respectively.