[Premature cervical ripening--surgical or conservative therapy?].

We studied the effect of the cerclage operation as treatment of premature ripening of the cervix in the 15.-35. week of gestation with a retrospective matched pair analysis (n = 142). For each patient in the group treated operatively (n = 71) a patient was selected, who was clinically comparable in parity, gestational age and cervix score at the time of diagnosis but was managed conservatively (n = 71). The study showed that the cerclage operation is not generally advantageous as treatment of premature cervical ripening. Because of the higher perinatal morbidity in the group treated by an operation, the unselected indication for a therapeutical cerclage is questioned. To define indications for cervical cerclage as operative treatment for premature cervical ripening we selected subgroups by history and clinical data treated either operatively or conservatively and evaluated their parameters of gestation, delivery and puerperium as well as the perinatal outcome. We found that the operative treatment was superior to the conservative therapy only in patients with premature cervical ripening before the 25th week of gestation and in patients with an "open cervix" and a history of miscarriage, abortion or premature delivery. The results of this study led to a proposal for the treatment of patients with premature ripening of the cervix, which has to be confirmed by prospective controlled studies.