Home > Journals > Minerva Obstetrics and Gynecology > Past Issues > Minerva Obstetrics and Gynecology 2021 October;73(5) > Minerva Obstetrics and Gynecology 2021 October;73(5):638-45

CURRENT ISSUE
 

JOURNAL TOOLS

eTOC
To subscribe PROMO
Submit an article
Recommend to your librarian
 

ARTICLE TOOLS

Publication history
Reprints
Permissions
Cite this article as
Share

 

ORIGINAL ARTICLE   

Minerva Obstetrics and Gynecology 2021 October;73(5):638-45

DOI: 10.23736/S2724-606X.21.04703-5

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Painless cervical dilation with “hourglass membranes”: conservative management

Isabel M. FONTÁN ATALAYA 1 , Andrea CARUSO 1, Almudena PEREA CRUZ 1, Bartolomé FERNANDEZ TORRES 2

1 Department of Obstetrics and Gynecology, Virgen Macarena Hospital, Seville, Spain; 2 Department of Anesthesiology and Reanimation, Virgen Macarena Hospital, Seville, Spain



BACKGROUND: Cervical competence is currently conceived as a continuous biological process with progressive degrees of insufficiency, this substituting the traditional vision of cervical competence as being present or absent. The most extreme expression of cervical insufficiency is known as “hourglass membranes”. Currently no consensus exists regarding the treatment of pregnancies complicated by the protrusion of amniotic membranes; however, the majority of authors agree on recommending bed rest and performing cervical cerclage, known as “emergent cerclage.”
METHODS: We describe a series of clinical cases corresponding to second-trimester pregnancies with cervical dilation and prolapsed amniotic membranes that were admitted to our hospital, managed with conservative treatment. All patients received the same basic treatment: intravenous fluid therapy for hydration, a single-oral-dose of azithromycin and intravenous antibiotic therapy for 7 days, vaginal micronized progesterone and indomethacin administrated orally.
RESULTS: Mean gestational age at diagnosis was 22.5 weeks with an extension of pregnancy between 2.1 and 16 weeks, with eight patients (72.72%) who extended their pregnancy for more than 8 weeks. In all cases, live fetuses were obtained, with favorable evolution.
CONCLUSIONS: Despite our limited experience, resulting from the low number of cases presenting, our results encourage us to propose conservative management in pregnancies complicated with a dilated cervix and membranes protruding into the vagina, as a reasonable alternative to surgical emergency cervical cerclage, which is currently considered the therapy of choice when extreme cervical shortening occurs in the second trimester of pregnancy.


KEY WORDS: Uterine cervical incompetence; Progesterone; Conservative treatment

top of page