Transabdominal Cerclage

Abstract

The transabdominal cerclage procedure was first introduced 50 years ago as an approach in those patients who had failed transvaginal cerclage. We review the history, indications, surgical technique, complications, and reported outcomes of the procedure. The procedure has evolved over time in its application and risks appear to be less than previously perceived. Physicians have found additional patient situations in which the procedure may be beneficial outside the indications defined 50 years ago. This is a valuable surgical technique which is likely underused.

Successful heterotopic pregnancy with prior radical trachelectomy after transabdominal cervico isthimic cerclage with methotrexate treatment

“…Sumners et al also mentioned that other non-classic indications for prophylactic transabdominal cerclage that may include severe cervical hypoplasia without history of cervical insufficiency, radical trachelectomy and higher order multifetal gestations. 3 Cerclages are usually placed after conception between 12 and 14 weeks of gestation, however, abdominal cerclages can be placed before conception or early in pregnancy. 8 In our case, since the patient visited our hospital at7 + 4 weeks of gestation, transabdominal cerclage had to be performed at earlier gestation than conventional.…”

“…According to Sumners et al, indication for transabdominal cerclage includes, in case of failure of a prophylactic vaginal cerclage within prior pregnancy or an exocervix which is significantly attenuated, either globally or focally. 3 They also mentioned that other non-classic indications for prophylactic transabdominal cerclage that may be considered include severe cervical hypoplasia without history of cervical insufficiency, radical trachelectomy, and higher order multifetal gestations. 3 We present a case of transabdominal cerclage in a heterotopically pregnant woman who had previously undergone radical trachelectomy.…”

“…3 They also mentioned that other non-classic indications for prophylactic transabdominal cerclage that may be considered include severe cervical hypoplasia without history of cervical insufficiency, radical trachelectomy, and higher order multifetal gestations. 3 We present a case of transabdominal cerclage in a heterotopically pregnant woman who had previously undergone radical trachelectomy. The ectopic gestational sac was injected with Methotrexate which led to a successful delivery of intrauterine pregnancy.…”

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

“…To prevent multiple laparotomies, a laparoscopic procedure might be an alternative option for such patients . Recently, robotic as well as laparoscopic approaches have been reported . However, it is difficult to locate avascular spaces between the uterine body and vessels using a laparoscopic procedure, especially after RT, because of the loss of the parametrial tissues, including cardinal ligaments .…”

“…9 Recently, robotic as well as laparoscopic approaches have been reported. 10 However, it is difficult to locate avascular spaces between the uterine body and vessels using a laparoscopic procedure, especially after RT, because of the loss of the parametrial tissues, including cardinal ligaments. 11,12 We believe that experts in laparoscopic surgery can perform laparoscopic TAC even under such conditions.…”