Abstract
The inability of the uterine cervix to retain a pregnancy in the second trimester is referred to as cervical insufficiency. The most common intervention for such cervical insufficiency to prevent preterm birth is a McDonald cerclage. However, the rate of success ranges from 40-90%. This 3 patient case series is the first report of supplemental use of a dehydrated amniotic membrane allograft (DAMA; BioDRestore®) at the cerclage suture sites as a means to improve success, measured by prevention of pre-term birth, reduction in complications of neonatal prematurity, and decreased length of hospitalization for mother and neonates.
Highlights
There has been an increase in diagnosis of short or incompetent cervix with the growing popularity of Loop Electrosurgical Excision Procedures (LEEP) during pregnancy [1]
We discuss the novel use of an injectable dehydrated amniotic membrane allograft (DAMA, BioDRestore®, Integra Lifesciences, Princeton, NJ) in conjunction with McDonald cerclage for patients with a history of second trimester pregnancy loss or preterm birth with early cervical dilation without uterine contractions
When DAMA was incorporated into the cerclage procedure for their third pregnancy, cervical measurement at each scan was increased in comparison to their previous pregnancies (Table 1, Figure 2)
Summary
There has been an increase in diagnosis of short or incompetent cervix with the growing popularity of Loop Electrosurgical Excision Procedures (LEEP) during pregnancy [1]. Depending on different processing methods, they can be stored at room temperature or in deep freezer for 2 – 5 years, which offers convenience for surgeons In this case series, we discuss the novel use of an injectable dehydrated amniotic membrane allograft (DAMA, BioDRestore®, Integra Lifesciences, Princeton, NJ) in conjunction with McDonald cerclage for patients with a history of second trimester pregnancy loss or preterm birth with early cervical dilation without uterine contractions. A 29-year-old female with, G3P1, presented to our clinic with 2cm cervical dilation at 21 4/7 weeks gestation without uterine contractions Her cervical length was measured at 2.3 cm and 1.9 cm with fundal pressure, with funneling. Frequent scans up to 30 weeks of gestation showed that her cervical length consistently increased over time without any funneling (table #1, Figure 2) She received steroids for fetal lung maturity and magnesium for neuro-prophylaxis. The patient had a spontaneous vaginal delivery of a healthy female infant weighing 3309 gm at 37 weeks of gestation
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