Successful Interval Laparoscopic Transabdominal Cervicoisthmic Cerclage Preceding Twin Gestation: A Case Report

Pereira, Ricardo; Zanatta, Alberto; Bianchi, Pedro Kastein Faria da Cunha; Yadid, I.M.; Motta, E.L.A.; Serafini, P.

doi:10.1016/j.jmig.2009.05.011

Cited by 10 publications

(6 citation statements)

References 11 publications

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“…The classic approach is by TAC during pregnancy, while some authors support the procedure prior to pregnancy [1, 5–10, 12–15]. More recently, laparoscopic transabdominal cervicoisthmic cerclage (LTCC) [10, 14] and even robotic techniques have been described [15]. In addition, one may consider performing TAC in the same session with trachelectomy performed for malignancy [16].…”

Section: Discussionmentioning

confidence: 99%

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Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Kyvernitakis

Lotgering

Arabin³

2014

Case Reports in Obstetrics and Gynecology

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Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

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Section: Discussionmentioning

confidence: 99%

“…A systematic review of the literature in PubMed and EMBASE for the match terms “twin pregnancy” and “transabdominal cerclage” revealed 6 publications [5–10] with 8 twin pregnancies. By inclusion of the 7 twin pregnancies from the dataset of Lotgering et al [3], a total of 15 twin pregnancies with TAC were available for analysis.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Kyvernitakis

Lotgering

Arabin³

2014

Case Reports in Obstetrics and Gynecology

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“…Moreover, the management of women with twin pregnancy who have a history of unsuccessful TVC is challenging. Only a few case reports have examined the use of TAC in twin pregnancy [8,[15][16][17][18][19][20][21][22]. Therefore, given the lack of sufficient evidence, it is unclear whether TAC is an effective procedure in women with twin pregnancy and unsuccessful TVC history, and the ability to counsel such women is limited.…”

Section: Introductionmentioning

confidence: 99%

Outcomes after transabdominal cerclage in twin pregnancy with previous unsuccessful transvaginal cerclage

et al. 2020

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Transabdominal cerclage (TAC) is reported to be effective for preventing preterm birth in women with unsuccessful transvaginal cerclage (TVC) history. However, TAC has rarely been performed in twin pregnancy given the lack of sufficient evidence and the technical difficulty of the operation. Thus, it is unclear whether TAC is an effective procedure for twin pregnancy in women with a history of unsuccessful TVC. The aim of this study is to compare the characteristics and pregnancy outcomes after TAC in twin pregnancy versus singleton pregnancy, to examine whether twin pregnancy is a risk factor for very preterm birth (before 32 weeks) after TAC, and to determine whether TAC is effective in preventing preterm birth in twin pregnancy. This single-center retrospective cohort study included women who underwent TAC because of unsuccessful TVC history between January 2007 and June 2018. Of 165 women who underwent TAC, 19 had twins and 146 had singletons. Our results showed that the neonatal survival rate improved dramatically when TAC was performed (15.4% (prior pregnancy) vs 94.0% (after TAC) in twins, p<0.01; 22.8% (prior pregnancy) vs 91.1% (after TAC) in singletons, p<0.01). Moreover, the risk of very preterm birth was significantly decreased after TAC in both groups (36/39 (92.3%) (prior pregnancy) vs 2/19 (10.5%) (after TAC) in twins, p<0.01; 290/337 (86.1%) (prior pregnancy) vs 17/146 (11.6%) (after TAC) in singletons, p<0.01). More advanced maternal age and history of prior preterm delivery between 26+0 and 36+6 weeks were independently associated with very preterm birth, whereas the presence of a twin pregnancy was not associated with very preterm birth on multivariate logistic regression analysis. These results suggest that TAC is associated with successful prevention of very preterm birth and improved neonatal survival rates in the absence of procedure-related major complications in women with twin pregnancy and previous unsuccessful TVC history.

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“…To prevent premature rupture of membranes and preterm delivery, therapeutic or prophylactic cervical cerclage is recommended for the treatment of cervical incompetence during the late first trimester or early second trimester of pregnancy [ 4 5 ].…”

Section: Introductionmentioning

confidence: 99%

“…Conventional treatment is cervical cerclage via the vaginal approach. However, in some conditions, cervical cerclage cannot be performed vaginally or it will not be effective because of anatomic cervical distortions, either congenital or as a result of previous surgical procedures [ 4 ]. Then, trans-abdominal cervicoisthmic cerclage (TCIC) can be considered.…”

Section: Introductionmentioning

confidence: 99%

Successful term delivery cases of trans-abdominal cervicoisthmic cerclage performed at more than 18 weeks of gestation

Joung

Kwack

et al. 2016

Obstet Gynecol Sci

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A 38-year-old nulliparous woman was referred to our clinic because of cervical incompetence at 19 weeks of gestation. Trans-abdominal cervicoisthmic cerclage was performed after failure of modified Shirodkar cerclage operation in the patient at 21 weeks of gestation via a laparotomic approach. Another 38-year-old patient, who underwent loop electrosurgical excision procedure conization for treatment of cervical dysplasia 4 years ago, presented for cervical incompetence. At 18 weeks of gestation, we performed trans-abdominal laparotomic cervicoisthmic cerclage without any post-operative complications. During antenatal follow-up, there were no obstetrical co-morbidities and finally she gave birth to a healthy infant at full term by cesarean section. We report two cases of women who underwent trans-abdominal cervicoisthmic cerclage surgery because of cervical incompetence as they were not suitable for transvaginal cervical cerclage. Both patients successfully maintained their pregnancy until full term after undergoing transabdominal cervicoisthmic cerclage at more than 18 weeks of gestation.

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Successful Interval Laparoscopic Transabdominal Cervicoisthmic Cerclage Preceding Twin Gestation: A Case Report

Cited by 10 publications

References 11 publications

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Outcomes after transabdominal cerclage in twin pregnancy with previous unsuccessful transvaginal cerclage

Successful term delivery cases of trans-abdominal cervicoisthmic cerclage performed at more than 18 weeks of gestation

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