CERCLAGEM HERÓICA DO COLO UTERINO

Abstract

INTRODUCTION: Cervical insufficiency (CI), whose incidence is estimated around 0,5% of all pregnancies, is the incapacity of the uterine cervix of keeping a second trimester pregnancy, even in the absence of signs and symptoms of labor, being associated with abortion or extreme prematurity. CASE REPORT: A 28 year old patient is diagnosed in her 21st week of pregnancy with prolapsed fetal membranes. Recommendation at the time was an amniocentesis, followed by emergency cerclage, pessary insertion and antibiotic prophylaxis. She presented with possible amniotic fluid embolism in postoperative, which was treated during six days of permanence in an intensive care unit. At 36w and 6d of pregnancy, the patient went into labor and after a few complications and a recommendation of cesarean section, mother and baby were fine. DISCUSSION: The risk of a premature labor in cases of CI combined with prolapsed fetal membranes is high and perinatal mortality in the absence of surgical intervention is 38% when diagnosis is made between 22 and 25 weeks of pregnancy. Evaluation of uterine cervix through ultrasound allows the measurement of cervix length, a marker of cervical competency, detection of uterine cervix tapering and prolapsed membranes. The cerclage is the recommended procedure, being performed in a prophylactic way, therapeutic or even in emergencies when there are prolapsed membranes, for example. However, the emergency intervention may confer important risk for the fetus and therefore the importance of preventing protrusion through early diagnosis of CI is essential.