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Cerchiaggio cervicale di emergenza sec. Wurm-Hefner

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Il cerchiaggio cervicale di emergenza ha una sua ragion d’essere soprattutto nell’assenza di chiare linee guida sull’uso del cerchiaggio di elezione. Il cerchiaggio di emergenza va effettuato in casi di osservazione estemporanea di gravida >24 settimane che presenta una cervice raccorciata (<2.5 cm) e funneling >40%.  La tecnica proposta da Wurm prevede una sutura a “U” o “a materassaio”. Lo strumentario è simile a quello di McDonald (filo di poliestere doppio armato con aghi a corpo cilindrico e punta tagliente  (fig. 1), placca posteriore di Sherbak (fig. 2) e placche di Breisky o Landau (fig. 3), pinze di Schroeder o Pozzi -fig. 4-).  Le percentuali di successo: > 85% (1). E’ consigliabile eseguire una profilassi antibiotica e tocolitica pre-operatoria. Occorre attenzione  nel porre le suture per il rischio di ledere le membrane amnio-coriali protrudenti nel canale cervicale. Ad evitare ciò, un aiuto può essere offerto dal controllo USG della cervice mediante scansione diretta della stessa dopo aver apposto l’ago e prima di passare il nastro di mersilene.

References:

1. HEFNER JD, PATOW WE, LUDWIG JM Jr.: “A new surgical procedure for the correction of the incompetent cervix during pregnancy. The Wurm procedure”. Obstet Gynecol. 1961 Nov;18:616-20.

2. Shennan A, Jones B. :The cervix and prematurity: aetiology, prediction and prevention. Semin Fetal Neonatal Med. 2004 Dec;9(6):471-9.

3. LYNN HD.: OPEN-LIGATURE EMPLACEMENT FOR CORRECTION OF INCOMPETENT CERVIX DURING PREGNANCY. Obstet Gynecol. 1965 Sep;26:377-80.

4. Althuisius SM. : “The short and funneling cervix: when to use cerclage?”. Curr Opin Obstet Gynecol. 2005 Dec;17(6):574-8.

 


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