Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage

Lee, Keun-Young; Jun, Hyun-Ah; Roh, Ju-Won; Song, Ji-Eun

doi:10.1016/j.ajog.2007.05.028

Cited by 18 publications

(15 citation statements)

References 3 publications

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“…Figures and show the representative pregnancy courses and treatments for Patient 1 after conization and Patient 2 after RT, respectively. Patient 2 was the first to deliver after TAC for cervical incompetence from RT . The cervical lengths of pregnant patients were longer than the position of the cerclage throughout pregnancy, except in Patient 6.…”

Section: Resultsmentioning

confidence: 97%

“…Although only one of five pregnant patients who underwent RT delivered, we believe nevertheless that TAC may be the most appropriate treatment modality for patients who have undergone RT and who have problems with cerclage performed at the time of trachelectomy, such as Patients 2, 3, 4, 7 and 8 in our study. However, only a few studies of TAC after RT have been reported . As a result of RT, the greater part of the cardinal ligaments is lost.…”

Section: Discussionmentioning

confidence: 99%

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Transabdominal cerclage (TAC) for patients with ultra‐short uterine cervix after uterine cervix surgery and its impact on pregnancy

Ishioka

Kim

Mizugaki

et al. 2017

J of Obstet and Gynaecol

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Aim: Patients with an ultra-short uterine cervix as a result of large conization, repeated conization or radical trachelectomy (RT), are at high risk of preterm premature rupture of the membrane, which leads to preterm birth. We have commenced performing transabdominal cerclage (TAC) of the uterine cervix for these patients. In this study, we examined the safety of TAC and its impact on pregnancy. Methods: We have performed TAC in 11 patients before pregnancy: in six after large cervical operations, such as repeated conization; and in five for difficulties with cervical cerclage after RT. After laparotomy, a Teflon thread was placed in the avascular space between the uterine vessels and the uterine muscle, and tied. The clinical course of the patients after TAC and their pregnancy course were retrospectively reviewed. Results: TAC was performed safely without any complications. The mean operative duration was 53 AE 10 min, and the mean blood loss during the operation was 49 AE 64 mL. Seven women conceived within 2 years after TAC. Their pregnancy courses were favorable. Five of the women underwent scheduled cesarean sections, while two pregnancies are ongoing. Conclusions: Although there are risks of various complications as a result of the use of non-absorbable thread and the need for two extra laparotomies, TAC can be a safe and useful option for patients who show cervical incompetence after large uterine cervical operations, such as RT or large conization.

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Section: Resultsmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Transabdominal cerclage (TAC) for patients with ultra‐short uterine cervix after uterine cervix surgery and its impact on pregnancy

Ishioka

Kim

Mizugaki

et al. 2017

J of Obstet and Gynaecol

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“…Only five reports on post‐trachelectomy “twin” deliveries (including six cases) have been published to date, using Pub‐Med and MEDLINE published in the English language between 1985 and 2018 with the key search word: “twin” and “trachelectomy”. These six cases are summarized in Table ; the mean gestational age at birth was 29 weeks.…”

Section: Discussionmentioning

confidence: 99%

“…Only five reports on post-trachelectomy "twin" deliveries (including six cases) have been published to date, [15][16][17][18][19] using F I G U R E 2 Serial measurements of the length of the 'neo-cervix' were performed, and revealed that it had shortened during pregnancy. A, neo-cervical length was 27 mm at 15 +1 wk on admission.…”

Section: Discussionmentioning

confidence: 99%

Multiple management strategies to prolong gestational period after radical trachelectomy

Ito

Yoneda

Shiozaki

et al. 2019

Clinical Case Reports

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“…A woman undergoing VRT does not have enough cervical tissue for supplementary vaginal cerclage, because cervix is amputated below cervical isthmus at the time of VRT. As TAC knot is placed higher than transvagincal cerclage, a slippage of the knot and an ascending infection may be decreased [6,7]. We suppose TAC could prevent CI and ascending infection following radical trachelectomy.…”

Section: Discussionmentioning

confidence: 99%

Successful term pregnancy after transabdominal cerclage with previous second trimester loss following vaginal radical trachelectomy

Song

Lee

Choi

2012

Korean J Obstet Gynecol

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The ultimate goal of radical trachelectomy is to have a viable pregnancy. However, extremely short cervix following radical trachelectomy could result in cervical incompetence and nonviable preterm delivery. Although prophylactic cerclage is placed at the time of radical trachelectomy, it might not be suffi cient to prolong pregnancy until term. We report a successful term pregnancy after transabdominal cerclage with previous second trimester loss following vaginal radical trachelectomy. Copyright © 2012. Korean Society of Obstetrics and GynecologyRadical trachelectomy was proposed to preserve fertility in women with early stage cervical cancer [1,2]. However, it is clear that cervical incompetence (CI), which leads to very early preterm birth, is common in pregnancy following radical trachelectomy [3,4]. We report a successful term pregnancy after transabdominal cerclage (TAC) with previous second trimester loss following vaginal radical trachelectomy (VRT). Case ReportA 29-year-old nulliparous woman presented to our institution for evaluation of a high-grade squamous intraepithelial lesion identifi ed on her Pap smear. A cervical punch biopsy showed a cervical intraepithelial neoplasia (CIN) III, and the patient underwent conization. The histology showed invasive squamous cell carcinoma with more than 4 mm in depth. She was assessed by clinical evaluation and was staged International Federation of Obstetrics and Gynecology (FIGO) stage IB1. As she strongly desired to preserve her fertility, she underwent VRT with laparoscopic bilateral lymphadenectomy. She was informed of the possibility of preterm birth after VRT. A concurrent prophylactic cerclage using monofi lament nonabsorbable polyprophylene (1-0 Prolene, Ethicon, Somerville, NJ, USA) was performed. The histology demonstrated invasive squamous cell carcinoma with 5 mm in depth and no involvement of resection margins. No lymphatic or vascular invasion was observed on pathology. A year later, she conceived spontaneously. However, she lost the fetus at 20 weeks of gestation resulting from CI. Next year, she presented to our institution for her second spontaneous pregnancy. She was in good health and her repeat Pap smear showed negative intraepithelial lesion. Transvaginal ultrasonography revealed short cervical length of CASE REPORT Korean J Obstet Gynecol 2012;55(5):332-334 http://dx

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Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage

Cited by 18 publications

References 3 publications

Transabdominal cerclage (TAC) for patients with ultra‐short uterine cervix after uterine cervix surgery and its impact on pregnancy

Transabdominal cerclage (TAC) for patients with ultra‐short uterine cervix after uterine cervix surgery and its impact on pregnancy

Multiple management strategies to prolong gestational period after radical trachelectomy

Successful term pregnancy after transabdominal cerclage with previous second trimester loss following vaginal radical trachelectomy

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