Cervical incompetence: diagnostic and therapeutic aspects.

During a seven-year period, 311 women with cervical incompetence were treated by cerclage. Fifty-three of the women were treated twice during the study period, 12, three times, and one, four times, so that a total of 391 pregnancies was studied. There were only 45 emergency procedures. Candidates for elective cerclage were selected on the basis of hysterographic findings and the Hegar test. Cerclage was performed by the simple McDonald procedure, usually during the 11th to 12th week of gestation, after the presence of fetal life had been established by ultrasonic detection of the fetal heartbeats. Apart from antibiotics no medical treatment was given. Hospitalization following cerclage was reduced to less than 24 h. The fetal salvage rate was 89%, with minor differences among four etiologic subgroups. The minimum benefit rate of the operations was 64.6%. The degree of cervical patency, as established by the Hegar test, was found to be of prognostic value in cerclage-treated pregnancies. Ultrasonic detection of fetal heartbeat before cerclage significantly improved fetal salvage by almost complete elimination of early fetal loss. Simplification of the surgical procedure is recommended.