Low-Cost Rescue Cerclage Technique in Second-Trimester Cervical Dilation With Bulging of Membranes

Cervical dilation associated with prolapsed fetal membranes is one of the leading causes of premature deliveries during the second trimester of pregnancy. Rescue cervical cerclage has been proven to prolong pregnancy by 4 to 5 weeks, reducing by 2-fold the risk of preterm birth before 34 weeks and seems superior to expectant management in the absence of chorioamnio-nitis, premature rupture of membranes and treatment-resistant uterine contractions. 1 Thus, cervical cerclage can be safe and effective with positive perinatal results in such cases. Optimal management remains unclear with various techniques, such as the McDonald procedure and the modi fi ed Shirodkar cerclage procedure. 2 Some in-terventions can increase the chance of success by reducing fetal membranes ’ pressure, such as amnioreduction, or by stretching the cervical canal, such as the full bladder technique. 3 Pushing back the fetal membranes into the uterine cavity and successfully performing the cerclage remains a technical challenge because of the membranes ’ risk of accidental rupture. Using the surgeon ’ s fi nger creates an obstacle to the cerclage due to the narrow vaginal space. Gauze and cotton balls can cause high friction, require additional force when pushing the membranes and are complicated to remove once the cerclage knot is done. Other instruments with a distal balloon, such as laparoscopy trocar, a rubber balloon or a balloon tamponade, can be used. 4,5 However, there are cost and availability issues. We describe