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INTRODUCTION: Replacement of exposed amniotic sac can be challenging in physical examination-indicated cerclage. Here we describe the use of Foley ripening cervical balloon for replacement of bulging membranes during cerclage placement. METHODS: This is a retrospective case series of patients presenting for a physical examination-indicated cerclage with membranes at or beyond external cervical os at two institutions between July 2021 and June 2023. Eligible patients were under 24 weeks with painless cervical dilation with no evidence of overt infection, abruption, or labor. Cook catheter balloon with a stylet was placed into cervical canal with the bladder empty and the patient in the Trendelenburg position. The uterine side of the balloon was inflated to 20 mL. The stylet was then advanced, and another 20 mL was added to the uterine balloon. A single suture was placed circumferentially with stylet in place. After initial tying down to the balloon catheter, the balloon was then deflated and the catheter was removed, tying the suture further down. Patients were given 24 hours of cephazolin and 48–72 hours of indomethacin. RESULTS: Our use of a cervical-ripening balloon was successful in all seven cases in reducing fetal membranes at time of cerclage placement. Median latency weeks between cerclage placement and fetal delivery was 14.00 weeks. Median gestational age at delivery was 36.71 weeks. CONCLUSIONS/IMPLICATIONS: Replacement of membranes at the time of physical examination-indicated cerclage may be aided with the use of a rigid cervical-ripening balloon catheter with a stylet in addition to perioperative antibiotics and indomethacin.
Sierra et al. (Thu,) studied this question.