Department of Obstetrics and Gynecology, University Hospital, Bologna, Italy.
Fetal Diagn Ther. 2013;33(4):265-7. doi: 10.1159/000338930. Epub 2012 Aug 8.
Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed.
A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin.
After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital.
This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes.
对于出现胎膜膨出的孕妇，可选择在妊娠中期行紧急宫颈环扎术。尽管该操作可能显著延长妊娠时间，但已有严重的胎儿和母体不良事件的报道。通过术前羊膜穿刺术排除感染已被提出。
一位 37 岁的女性，孕 4 产 1，因胎膜膨出于妊娠 21 周入住我院。为排除真正的羊膜感染，进行了羊膜穿刺术。我院微生物学部发现羊水细菌和支原体培养均为阴性，葡萄糖和白细胞介素-6 水平正常，因此行宫颈环扎术。患者出院时口服红霉素。
48 小时后，患者出现高热、寒战和胎动减少。入院时超声显示无胎心活动，环扎后取出胎儿，发现为死胎并经阴道娩出。开始使用哌拉西林他唑巴坦，但患者病情恶化，出现冷脓毒性休克，行子宫切除术，并转入我院 ICU。
即使羊水穿刺阴性，对于因胎膜膨出而行紧急宫颈环扎术的孕妇，也不能排除危及生命的感染。
