Laparoscopic trans-broad-ligament abdominal cerclage with round ligament suspension to create a space in the pouch of Douglas (LAC-D) during pregnancy.

Robotic-assisted laparoscopic cerclage in a pregnant patient

Effect of transabdominal versus transvaginal cerclage on preterm birth and neonatal outcomes among patients with a history of cervical insufficiency.

Transabdominal vs transvaginal cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis.

Objective: To explore the surgical opportunity of the transvaginal cervicoisthmic cerclage in the treatment of the cervical incompetence and the effect on the pregnancy outcomes. Methods: A Retrospective controlled trial was carried out between January 2014 and December 2018 in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China and a total of 1 027 patients with cervical incompetence underwent the transvaginal cerclage. According to the different surgical opportunity, the patients were divided into two groups: the conception cerclage (n=736) and the preconception cerclage (n=291), and the former were divided into two subgroups depending on the condition of the cervix, the history indicated conception cerclage (n=511) and the ultrasound indicated conception cerclage (n=225). Main outcome measures were the gestational age, term delivery rate, the fetal weight and the fetal survival rate. Results: After the cerclage, the gestational age was (36±4) weeks, the term delivery rate was 69.6% (710/1 020), the fetal weight was (3 038±624)g and the fetal survival rate was 94.7% (966/1 020). Compared with the ultrasound indicated conception cerclage subgroup, the gestational age, the term delivery rate, and the fetal weight were all significantly higher in the history indicated conception cerclage subgroup [(37±4) vs (36±5) weeks, t=2.691; 72.8% vs 62.7%,χ(2)=7.593; (3 091±594) vs (2 963±756) g, t=2.396; all P<0.05], but the fetal survival rate was comparable in these two groups(95.3% vs 92.9%, χ(2)=1.772, P>0.05). There were no significant differences in the gestational age, the term delivery rate, the fetal weight and fetal survival rate between the history indicated conception cerclage and the preconception cerclage (all P>0.05). Conclusion: The transvaginal cervicoisthmic cerclage is a promising and safe technique for improving obstetric outcomes in women with cervical incompetence, and the history indicated conception cerclage is better than the ultrasound indicated cerclage.

This publication offers an in-depth study of the fish and other organisms that live in Lakes Mead and Mohave. The history and background of the two lakes is offered, as well as information about diseases, parasites, and unusual fish occurrences. Food sources, predation and competition are also discussed.

Counseling a Patient on Laparoscopic Abdominal Cerclage Placement

Cervical cerclage vs cervical pessary in women with cervical insufficiency: A multicentric, open-label, randomised, controlled pilot trial [the CEPEIC trial]

Background: The diagnosis of cervical insufficiency is based on the previous history of recurrent second or early third trimester losses. Its incidence among pregnant women is 0.5–1% but can be as high as 75% among women with preterm birth. Transvaginal cerclage (TVC) is the common therapy of cervical insufficiency. However, this technique has several limits, especially in twin pregnancies. As some selected conditions, a transabdominal cerclage (TAC) is indicated, it has been offered to patients with multiple pregnancies.Aim: To evaluate the outcomes of twin pregnancies with transabdominal cerclage in terms of preterm birth rate and neonatal morbidity and mortality.Materials and methods: We conducted a retrospective study of seven patients with twin pregnancies managed with transabdominal cerclage at the end of the first trimester (12–15 weeks). We selected patients with a history of fetal loss who met the indications criteria of TAC (history of TVC failure or short cervix unable to have TVC). The antenatal and delivery data were collected and compared to those of their previous pregnancy.Outcomes: All patients carried their pregnancy throughout the second trimester and delivered during the third trimester. Mean gestational age was 34 4/7 week. All newborns were alive and neonatal morbidity rate was 50%, mostly related to preterm birth. Mean duration of neonatal intensive care stay was 32 days. There were no operative complications following TAC.Conclusions: Perinatal outcomes are considerably improved in twin pregnancies with transabdominal cerclage. Our findings corroborate those of previous case reports and support the efficacy of TAC for managing cervical insufficiency in twin pregnancies.

Patients with a prior failed transvaginal cerclage: A comparison of obstetric outcomes with either transabdominal or transvaginal cerclage

Vaginal progesterone or cerclage to prevent recurrent preterm birth?

Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies.

Cervical cerclage is used to prevent preterm delivery caused by cervical insufficiency, thereby reducing neonatal morbidity and mortality rates. Transabdominal cerclage is usually performed in women who previously underwent transvaginal cerclage that failed to prevent pregnancy loss, or in those with a short cervix where transvaginal cerclage was not feasible. To estimate the efficacy of pre-conceptional laparoscopic cerclage in facilitating term delivery and live birth. A systematic review was conducted according to the PRISMA 2020 guidelines. This study was registered in PROSPERO (CRD42024545316). A search was conducted up to the 15th of April 2024, in the PubMed and Cochrane databases, using a combination of terms "laparoscopy", "transabdominal" and "cerclage". Original studies investigating the role of pre-conceptional laparoscopic cerclage on pregnancy outcomes after follow-up were eligible for inclusion in this review. Prevalence of deliveries after 37 weeks of gestation and live birth rates. Ten studies involving 1060 patients were included. The pooled prevalence of deliveries after 37 weeks of pregnancy was 70% [95% confidence interval (CI) 60%-79%, 7 studies, 515 pregnancies, I2: 85%] and the pooled prevalence of live birth was 92% (95% CI 86%-95%, 10 studies, 713 pregnancies, I2: 69%). Significantly higher rates of delivery after 37 weeks of pregnancy were associated with the use of mersilene tape compared to conventional sutures [odds ratio (OR): 2.98, 95% 1.95-4.56] and the use of an anterior knot compared to a posterior knot (OR: 2.26, 95% CI: 1.50-3.40). Pre-conceptional laparoscopic cerclage achieved high rates of live birth after 37 weeks in women considered at high risk of preterm delivery. Comparative research is needed to better understand the efficacy of pre-conceptional laparoscopic cerclage as well as refine the indications for this procedure, optimise surgical techniques, and determine the best timing for cerclage placement. Pre-conceptional laparoscopic cerclage may prevent future preterm births and second-trimester pregnancy losses.

Predictivity of uterine artery, arcuate artery, and intraovarian artery Doppler indices measured on the day of human chorionic gonadotropin injection on pregnancy outcomes

Cervical incompetence is a recognized cause of recurrent pregnancy losses in the second trimester. Abdominal cerclage, a less common surgical technique than transvaginal cerclage, may be a viable option in cases where transvaginal procedures have failed or are contraindicated. This report describes the case of a 34-year-old patient with severe cervical incompetence, characterized by recurrent pregnancy losses in the second trimester, despite having undergone multiple transvaginal cerclages without success. It was decided to perform an abdominal cerclage by laparotomy, with the placement of a permanent suture around the upper portion of the cervix, at the transition to the uterine isthmus. A direct comparative intervention was not performed, as previous attempts with transvaginal cerclage were unsuccessful. However, a theoretical comparison with transvaginal techniques is addressed in terms of efficacy and safety. The intervention allowed the patient to carry a pregnancy to term, culminating in a cesarean delivery without significant obstetric complications. Postoperative follow-up revealed no complications derived from the abdominal cerclage. Abdominal cerclage proved to be an effective therapeutic option in this patient with severe cervical incompetence, where transvaginal methods had failed. This case highlights the importance of considering abdominal cerclage in patients with refractory cervical incompetence, highlighting its potential to achieve successful pregnancies

Cervical insufficiency (CI) is a serious complication of pregnancy, which can cause preterm birth. Identifying how to most effectively treat CI has the potential to maximize neonatal survival in this population of women. To determine whether transabdominal cervical cerclage should be offered as a first-line treatment option in high-risk women. An electronic literature search for relevant studies was conducted using keywords (CI, cervical cerclage) on the MEDLINE database. Although transabdominal cerclage (TAC) is reserved as a second-line treatment option over transvaginal cerclage (TVC), it has some advantages over TVC: a higher placement of the suture at the level of the cervicoisthmic junction; avoidance of placement of foreign material in the vagina, in turn, reducing risk of infection and inflammation, which can propagate preterm labor; and the option to leave the suture in place for future pregnancies. Systematic review evidence offers TAC as a more effective procedure to TVC in reducing preterm birth and maximizing neonatal survival. Although TAC is a slightly more complex procedure compared with TVC, advances in minimally invasive surgery now allow gynecologists to perform this more effective procedure laparoscopically and therefore without the added morbidity of open surgery but with the same if not better outcomes. Laparoscopic TAC can provide a more effective treatment option for CI without the added burdens of open abdominal surgery. Our article highlights future directions for study in the area of cervical cerclage and refinement of existing practices.