An Aid to Cervical Cerclage

Abstract

Closure of the incompetent internal cervical os by whatever method presents few technical difficulties when attempted before effacement and dilatation have occurred. In the latter situation, unless the protruding fetal membranes can be reduced safely, their rupture during placement of the sutures is sometimes difficult to avoid. The following procedure has been evolved to facilitate the operation.

Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

“…We placed the patient in the Trendelenburg position, and put the vaginal valves in order to see the uterine cervix, to evaluate its dilation and to check the integrity of amniotic membrane. Then, we prepared a regular Foley catheter (Charriere 16), adapted for this purpose by resection of the end a few millimeters above the balloon system in order to preserve its integrity; subsequently, we did endouterine replacement of the lower pole of the membranes above the internal uterine orifice level, according to the technique reported by many authors [19-21]. We tried to place the Mersilene tape as high as possible on the uterine cervix, using a combination of the Shirodkar and McDonald’s techniques, following described.…”

Incompetence of the Cervix

“…Earlier, the membranes were reduced by wet swabs. Following a communication by Orr (1973), a Foley catheter (30 ml) with the tip cut off has been used successfully to reduce the bulging bag of forewaters in the occasional case now seen. The balloon is inflated with water after introduction of the catheter through the external 0s.…”