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Abstract Background Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome. Case presentation A patient presented with vaginal spotting around 23 weeks. She has a history of four preterm deliveries. Her cervix was dilated and a cerclage was placed. She presented again with PPROM around 25 weeks. She went into spontaneous preterm labor and delivered a viable fetus that is a healthy girl today. Eventually the pathology of the placenta showed a complete hydatidiform mole. Conclusion It is necessary to inform patients about the potential risks and poor outcomes of this condition. For those who desire all potential interventions, cerclage placement could be considered.

Objective: To evaluate whether amniotic fluid markers can aid the decision of whether to retain or remove a cervical cerclage after preterm premature rupture of membranes (PPROM)., Methods: A retrospective cohort study included pregnancies involving PPROM after diagnostic amniocentesis and cerclage placement. Cerclage was retained for more than 12 hours after PPROM in the study group (n=18); the comparison group comprised women who underwent immediate cerclage removal after PPROM (n=22). Analyses were performed using concentrations of interleukin (IL)-6, glucose, and white blood cells (WBCs) in the amniotic fluid to measure relationships with adverse outcomes., Results: The latency period from PPROM to delivery was significantly shorter in the group that underwent immediate cerclage removal (P<0.005). Latency periods of more than 48 hours (P<0.001) and more than 7 days (P<0.01), and chorioamnionitis (P<0.05) were associated with cerclage retention. Neonatal outcomes were not significantly different between the study group and the comparison group. However, elevated IL-6 levels were associated with cumulative neonatal morbidity (P<0.05). Low IL-6 (P<0.001) and WBC (P<0.05) levels were significantly associated with a latency period of more than 7 days., Conclusion: Amniotic fluid levels of IL-6 and WBCs may be of clinical value for individualizing the management of patients with PPROM after cerclage., (Published by Elsevier Ireland Ltd.)

Objective: To determine whether amniotic fluid (AF) inflammation, in the absence of infection, is associated with adverse pregnancy outcomes in nonelective cervical cerclage patients., Methods: A retrospective case-control study was carried out. The patient population included 82 singleton pregnancies with negative AF cultures. The variables used to define AF inflammation were white blood cell count (WBC) >50 cell/mm(3), glucose <14 mg/dl or interleukin-6 (IL-6) >11.3 ng/ml. The study group consisted of cases with intra-amniotic inflammation. Sub-analysis was performed for the groups in which IL-6 concentrations were measured. Adverse outcomes were evaluated with variables such as gestational age at delivery, interval from cerclage to delivery, chorioamnionitis and cumulative neonatal morbidity., Results: Elevated AF WBC was correlated with severe and extreme preterm delivery (p < 0.05). Decreased AF glucose was associated with histological chorioamnionitis and a decreased cerclage to delivery interval (p < 0.05). Elevated AF IL-6 correlated significantly with decreased gestational age at delivery (p < 0.012) and decreased cerclage to delivery interval (p < 0.001). Elevated IL-6 concentrations were associated with severe, extreme preterm delivery (p < 0.001) and neonatal death (p < 0.001)., Conclusion: Elevated AF IL-6, elevated WBC and low AF glucose, in the absence of a positive AF culture, are significantly associated with adverse pregnancy outcomes in patients undergoing nonelective cerclage.

Objective: Prenatal prediction of neonatal survival and survival without short term major morbidity (STMM) in babies born at the borderline of viability., Methods: Obstetric and neonatal records of 471 babies born from 22 0/7 to 25 6/7 weeks between the years 2000 to 2007 were reviewed. A total of 179 live-born nonanomaluos singleton infants with birth-weights of 300-1397 g, who underwent ultrasonographic examination < 7 days before delivery, qualified for the study. Ultrasound biometry, use of antenatal steroids, fetal gender, race, gestational age, estimated fetal weight, and maternal medical and obstetric characteristics were evaluated. Univariate analyses, logistic regression, and bootstrapping using 10,000 resamplings were performed to derive prediction formulas that projected neonatal outcomes. From these, quantitative patient-specific prenatal estimates of neonatal survival and survival without STMM were calculated., Results: On the basis of the use of prenatally available parameters, neonatal survival was predicted with a sensitivity of 85.5% and specificity of 70.6%. Area under ROC curve (95%CI) = 0.835 (0.777-0.894). Corresponding values for survival without STMM were 94.7% and 34%. Area under ROC curve (95%CI) 0.738 (0.640-0.836). Among positive predictors of survival it is worth mentioning: intact membranes, femur length ≥ 39.1 mm and estimation of fetal weight > 493 g., Conclusion: Prenatal prediction of neonatal survival and STMM was achieved. This approach has the potential improve counseling and obstetric decision making at the borderline of viability.