”The 11th National Obstetrics and Gynecology Symposium of the Chinese Medical Association”, Obstetrics and Gynecology, Hyperemesis Branch. Professor Zhang Jianping from Sun Yat-sen Memorial Hospital of Sun Yat-sen University gave a lecture on “Surgical indications for emergency cervical cerclage and postoperative management”. China Obstetrics and Gynecology Network: Cervical insufficiency mainly causes preterm labor and mid- and late-term recurrent miscarriage, with an incidence of 8% to 15% in recurrent miscarriages. Could you please talk about the significance of emergency cervical cerclage? Prof. Zhang Jianping: Emergency cervical cerclage is an important method to restore the anatomical structure of the cervix. In the past, there was no good treatment for patients with cervical insufficiency and wide opening of the uterus at 24-26 weeks of gestation, and they had to give up the fetus, so it was called “unavoidable abortion”, but now some patients can extend the gestation week through emergency IUD, so that the fetus can be viable. The concept of unavoidable miscarriage has been reversed and it is possible to save the fetus through this procedure. China Obstetrics and Gynecology Network: What are the results of emergency laparoscopy? Prof. Zhang Jianping: We have reviewed the outcome of 158 emergency cervical cerclage cases in our hospital in the past 10 years, and the neonatal survival rate has reached 80%. China Obstetrics and Gynecology Network: How should we choose the indications for the procedure? Prof. Jianping Zhang: Not all dilated uterine orifices are suitable for emergency annuloplasty: even if infection is ruled out and contractions are not significant, patients who are considered to have cervical opening that may be caused by cervical insufficiency should be evaluated according to the degree of cervical opening. A large opening of the uterus, less than 3 cm, has a high success rate. The success rate is low when the opening of the uterus is greater than 4 cm, and the outcome of the procedure is related to the degree of opening of the uterus. China Obstetrics and Gynecology Network:What are the contraindications to emergency cervical cerclage? Prof. Zhang Jianping: Emergency cervical cerclage is not suitable for those who have frequent contractions and those who have signs of infection. China Obstetrics and Gynecology Network: What kind of anesthesia is used for emergency cervical cerclage? Prof. Jianping Zhang: Commonly used methods: epidural or subarachnoid anesthesia. The key to selection is: avoiding intraoperative hypoxia, hypotension, hypovolemia, acidosis, hypercapnia and hypocapnia. China Obstetrics and Gynecology Network: What should we pay attention to before and during surgery? Prof. Zhang Jianping: After the patient is admitted to the hospital, detailed medical history should be inquired, including the history of menopause, menstruation, pregnancy and delivery, especially the history of previous miscarriage, cervical injury and lesions. Find out the relevant tests for cervical insufficiency before pregnancy and whether the patient is currently unwell. Obstetric ultrasonography is performed to rule out fetal abnormalities. Routinely do vaginal discharge examination including: trichomonas, candida, bacterial vaginosis, cleanliness, etc. and cervical swab for mycoplasma, chlamydia, etc. Surgical techniques to be mastered during the operation: the opening of the uterus is wide and the amniotic sac is easily punctured during surgery, so the operation needs to be gentle. Suture as close to the inner cervical opening as possible for good results. The cervix is fully exposed during the operation and the sutures allow the fetal membranes to retract after the operation. The choice of procedure: McDonald’s procedure, Shirodkar’s procedure, U-shaped suture. We commonly use the purse-string suture, also known as the McDonald procedure. China Obstetrics and Gynecology Network: How should we manage the patient after surgery? Prof. Jianping Zhang: Postoperative management is very important, and it is an important part of ensuring the success of the surgery. After surgery, first of all, active prevention of infection and monitoring of infection indicators. The anatomy and barrier function of the cervix are destroyed after the opening of the uterus, and these patients are prone to chorionic villus infection, contractions and wound laceration. Secondly, ultrasound is needed to monitor cervical changes. In addition, these patients have a weak cervix, and contraction inhibitors should be correctly selected and used to minimize physiological contractions, and the side effects of contraction inhibitors should be monitored during the administration of the medication to ensure the safety of pregnant women. Long-term bedridden patients also need to pay attention to the prevention of deep vein thrombosis of the lower limbs . The choice of the time of stitch removal after surgery: the sutures will be dilated above the sutures, which is not an absolute indication for stitch removal. The stitches should be removed according to the condition. If strong contractions occur, the opening of the cervix is wide, and the dilatation above the cervical suture is severe, the stitches need to be removed in time. Emergency cervical cerclage can significantly improve pregnancy outcome, but the procedure is difficult and risky. We should master the indications, grasp the timing of the procedure, improve the surgical technique, and pay attention to postoperative management to maximize the clinical benefit of the patient. China Obstetrics and Gynecology Network: Emergency cervical cerclage has brought good news to patients, and we hope we can master this technique through study and practice to better serve the clinic. Thank you, Professor Zhang, for accepting the live interview with China Obstetrics and Gynecology Network.