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

Abstract

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.

Can prophylactic transvaginal cervical cerclage improve pregnancy outcome in patients receiving cervical conization? A meta-analysis

“…There were two reasons for this. Firstly, when searching the literature, we only retrieved some case reports relating to transabdominal cervical cerclage after cervical conization [31][32][33][34].…”

Transabdominal Cerclage: Different Indications, Optimal Outcome. Two Case Reports

“…In patients presenting in early pregnancy, a transabdominal cerclage should be placed in the late first trimester to early second trimester as the risk of miscarriage is lower than earlier in gestation, major structural anomalies can be excluded by ultrasound, early aneuploidy screening can be performed, and the uterus is not too large to make it technically challenging [10].…”

Transabdominal Cerclage Placement in a Gravid Patient at Week 22 of Gestation Period: A Case Report and Review of the Literature

“…However, this procedure is feasible until the 16 th -17 th week of pregnancy [12]. After the 17 th week, the size of the uterus makes laparoscopic TAC unattainable and laparotomic approach the only option for patients with CI who cannot have TVC, after the first trimester of pregnancy [5].…”

“…TAC placement may have difficulties, mainly attributed to uterine manipulation, because of the advanced gestational age; excessive manipulation may cause uterine contractions and as a result, preterm labor or membrane rupture [5]. Inappropriate placement of the cerclage band in the area of the uterine artery branches may cause excessive bleeding, or even trauma to the ureters.…”

“…Cervical insufficiency is usually treated with transvaginal cerclage [TVC] placement, especially when the cervical length is less than 15 mm or when there is a history of miscarriage, preterm labor or prior surgical procedures at the cervix such as trachelectomy or conization. However, there is a number of cases in which TVC cannot be technically performed or may not be effective [5]. In these women, transabdominal cerclage [TAC] placement may be the optimal alternative.…”