Transabdominal Cervicoisthmic Cerclage Research Articles

Laparoscopic abdominal cerclage during pregnancy: a simplified approach

Cervical insufficiency is a major cause of second-trimester pregnancy loss and spontaneous preterm delivery. Transabdominal cervicoisthmic cerclage is usually performed before pregnancy for patients of cervical insufficiency, in whom transvaginal cervical cerclage procedure cannot be placed or has failed previously. Performing a transabdominal cerclage becomes a huge challenge owing to the enlargement of the pregnant uterus in patients who were indicated for transabdominal cervicoisthmic cerclage but were missed before pregnancy. Here, we have outlined an easy and effective surgical procedure as needle-free laparoscopic trans-broad-ligament cervicoisthmic cerclage during early second-trimester. Laparoscope with 4 trocars was established, after expanding the trigonum of ureter, ovarian vascular and ascending branch of uterine artery. The needleless Mersilene tape was inserted in a posterior-to-anterior direction of bilateral trigonums, tightening the knot toward the bladder uterine reflection and simultaneously pushing the loop behind the uterus, directed to the cervix progressively. The tape was then tied anteriorly at the cervico-isthmic junction with 5 to 6 intracorporeal square knots after transvaginal ultrasound determined the presence of systolic velocity of uterine artery with first knot. The primary feature of our procedure was that the needleless Mersilene tape was inserted centrally from the broad ligaments, lateral to the uterine vessels, and finally tied above the uterosacral ligament at the level of the uterine isthmus, without dissecting the bladder off from lower uterine segment and without separating the uterine vessels from the lateral wall of the cervix. We performed this procedure on 10 patients with pregnancy outcomes and there was no pregnancy loss. This procedure proved to be an accessible and effective surgical technique for transabdominal cerclage of the uterine cervix during early-second trimester, with affirmative prognosis.

A modified transabdominal cervicoisthmic cerclage with the monofilament thread: Its efficacy and safety for women with extremely short cervix due to cervical conization.

The study aimed to examine the usefulness of modified transabdominal cervicoisthmic cerclage (TAC) using monofilament thread for the prevention of preterm delivery in women with an extremely short cervix after deep conization. We devised a monofilament thread for picking up the seromuscular layer of the site that is slightly cephalad to the internal ostium to prevent injury of the vessels around the uterine cervix. From 2017 to 2020, we performed this modified operation in eight women (nine pregnancies) at 12-16 weeks of gestation with a history of deep cervical conization. A modified TAC was successfully performed in all patients. There was no measurable bleeding, and all patients were discharged without postoperative complications. Their pregnancy courses after the operation were uneventful. Of nine, one patient had premature uterine contractions and underwent cesarean section at 36 weeks (preterm delivery). In the other eight pregnancies, planned cesarean section was performed after 37 weeks of gestation. The median birth weight of the babies was 2996 g (range 2604-3374 g). All patients were discharged on the sixth postoperative day without complications. A modified TAC can be safely performed and may prolong pregnancy without adverse events in patients with an extremely short cervix.

Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors.

This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.

Two successful live births following trans-abdominal cervicoisthmic cerclage in a woman with recurrent miscarriages

Cervical insufficiency, previously known as cervical incompetence, has been described as painless cervical dilation that leads to mid-trimester miscarriage in the absence of other causes. Recently, it has expanded to include women with a prior spontaneous preterm birth and evidence of cervical shortening (<25mm) on transvaginal ultrasound at a gestational age less than 18 weeks. Cerclage is an obstetric procedure performed for prevention of miscarriage and preterm birth in women with cervical incompetence; it can be done via vaginal or abdominal route. We present a case of a 32-year-old woman, now P2+5 (2 alive), with a history of five recurrent midtrimester pregnancy losses who was evaluated and worked up for abdominal cerclage after several failed cervical cerclages, who later had two successful pregnancies and deliveries via elective caesarean section. This case is presented as a reminder that such cases still exist, and the skill must be passed on to a younger generation of doctors as it may become useful when such cases are presented.

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

A Case of Successful Spontaneous Pregnancy after Laparoscopic Radical Trachelectomy with Trans-Abdominal Cervicoisthmic Cerclage Treatment

The Feasibility of a Modified Method of Laparoscopic Transabdominal Cervicoisthmic Cerclage During Pregnancy.

To evaluate a modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) technique after failure of transvaginal cerclage during pregnancy in women with cervical weakness. Eighty women in whom transvaginal cerclage was unsuccessful or who were anatomically unsuitable for the procedure underwent modified LTCC between January 2003 and December 2008 at Keimyung University, Dongsan Medical Center, Daegu, South Korea. The modified LTCC was performed using a polyfilament polyester double-armed needle that was sutured laterally to the uterine vessels at the level of the internal cervical os. Survival of the fetus was used to calculate the successful pregnancy rate of this modified LTCC. The relationship between successful pregnancy rate and clinical variables was evaluated using a chi-squared test and a Mann-Whitney U test. The mean gestational age was 12.1 weeks (range, 11-15 weeks). The operation time was 52 minutes (range, 25-100 minutes). The successful pregnancy rate was 90% (72/80 pregnancies), with a mean gestational age of 36.3±2.7 weeks. The mean newborn weight was 2690 g (range, 1860-3750 g). Eight pregnancies were lost in the first and second trimesters due to spontaneous abortion, premature rupture of the membrane, and termination due to anomaly; no other complications occurred. No statistical difference was found between the successful pregnancy rate and the measured clinical variables. The modified LTCC is feasible and safer than traditional LTCC.

Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization

Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices?

ABSTRACTObjectiveTo assess the reduction in fetal loss following transabdominal cervicoisthmic cerclage done for repeated failed vaginal cerclages and/or inaccessible cervices.Study designAn observational study of 113 pregnancies in 90 women after transabdominal cervicoisthmic cerclage from January 1999 to December 2010 at Fernandez Hospital, Hyderabad, Andhra Pradesh, India.ResultsMean gestational age at the time of elective transabdominal cervicoisthmic cerclage was 11.6 weeks. Patients were delivered by lower segment cesarean section (LSCS) with a mean gestational age of 36 weeks. Live birth rate was 90.5%. Incidence of mid-trimester miscarriages was 8.6% after cerclage compared with 62.9% before cerclage. Before cerclage, only 13.1% pregnancies continued beyond 28 weeks whereas after cerclage, 88.6% crossed the period of viability. Prior to cerclage, preterm delivery rate was 7.0% (as majority of the pregnancies were lost prior to period of clinical viability) and only 13.6% of these preterm babies survived. Although the incidence of preterm deliveries was 23.8% after cerclage, 80% of these preterm babies survived. Excluding first-trimester miscarriages, fetal loss was 93.3% prior to cerclage and 13.7% postcerclage. In effect, the take home baby rate among pregnancies was only 5.8% before cerclage compared with 86.7% after cerclage. Mean birth weight after cerclage was 2.5 kg.ConclusionTransabdominal cerclage reduces fetal loss and improves pregnancy outcome in women who had failed vaginal cerclages and in those with inaccessible cervices.How to cite this articleMarakani LR, Dasari S, Gundabattula SR, Joseph E. Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices? Int J Infertility Fetal Med 2013;4(1):1-5.

Before Conception Laparoscopic Cervical Cerclage Using Cerclage Tape

To evaluate the feasibility and safety of laparoscopic transabdominal cervico-isthmic cerclage (LTCC) before conception using Mersilene tape Clinical practice since Dec. 2008 to Dec. 2010. Teaching Hospital. Seven cases were performed LTCC who had 31 times second Trimester miscarriage. Three patients had the history of previous failed vaginal cervical cerclage. LTCC was performed using Mersilene tape at the level of the internal cervical os in the non-pregnancy period. The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in seven cases. One year after surgery one case had delivered a live baby by cesarean section in 38w gestation, birth weight 3600gm. Six cases didn't pregnant yet in whom 1 case suffered from bilateral fallopian tube occlusion. Laparoscopic cervical cerclage is feasible and effective as well as technically feasible and safe for a surgeon trained in laparoscopic suturing methods.

Transvaginal cervicoisthmic cerclage using a polypropylene sling: Pregnancy outcome

To report pregnancy outcome following prophylactic transvaginal cervicoisthmic cerclage using a polypropylene sling in a population of high-risk pregnant women. A retrospective study with a continuous series of 57 women presenting with prior failure of McDonald cerclage (n = 47) and/or absent portio-vaginalis of the cervix (n = 10). Cervicoisthmic cerclage was performed between 12 and 16 weeks of gestation (median 14 weeks' gestation). No intraoperative complication occurred. Preterm labor treated with parenteral tocolysis occurred in 14 women (24%). Cesarean delivery was systematically performed. Median gestational age at delivery was 37.2 weeks' gestation (interquartile range: 36.5-38.0). Overall neonatal survival rate was 94%. Transvaginal cervicoisthmic cerclage using a polypropylene sling may be considered as an effective alternative to the transabdominal cervicoisthmic cerclage in women presenting with previous cerclage failure.

Fertility Outcome Following Transvaginal Cervicoisthmic Cerclage Using a Polypropylene Sling

Transabdominal cervicoisthmic cerclage is beneficial in most women with cervical incompetence, for whom a conventional transvaginal procedure is inadequate or would be impossible. A large number of studies have reported that the fetal survival rate after the procedure increases from 70% to 95%. The high morbidity, however, associated with transabdominal cervicoisthmic cerclage limits its use. Recent studies have shown that a new procedure for transvaginal cervicoisthmic cerclage, using a macroporous monofilament polypropylene sling, may be an effective minimally-invasive alternative to transabdominal cervicoisthmic cerclage in women who present with a previous cerclage failure. This study evaluated the effect of the new procedure on the fertility and subsequent pregnancy outcomes among 57 women who underwent prophylactic transvaginal cervicoisthmic cerclage in a previous (reference) pregnancy, because of a high risk for preterm delivery. At 12 months or more after the reference pregnancy, telephone interviews were conducted to assess each patient's subsequent fertility. Of the 57 women interviewed, 8 had an inadequate follow-up of less than 12 months, 13 were lost to follow-up, 2 women required removal of the sling after cesarean delivery, and 1 needed a hemostatic peripartum hysterectomy. Among the other 33 women interviewed, 14 desired a subsequent pregnancy and 19 did not. One of the 14 women wanting a subsequent pregnancy had previously known tubal infertility and did not undergo in vitro fertilization. A total of 7 (54%) of the 13 subsequently became pregnant with the following outcomes: 1 had a spontaneous abortion at 11 weeks of pregnancy; 1 delivered at 22 weeks after spontaneous premature membrane rupture; 1 had a cesarean delivery at 25 weeks; and 4 had a term cesarean delivery at a median duration of 37 weeks (interquartile range = 37-38 weeks). The median birth weight of the 4 neonates was 3040 gm (interquartile range = 2500-3250 g). The investigators concluded from these findings that, subsequent successful pregnancy is possible when a transvaginal cervicoisthmic cerclage (specifically a polypropylene sling) is in place.

Translocation of a cerclage band into the endocervical canal after preconception transabdominal cervico‐isthmic cerclage

A 34-year-old woman, who had a history of five spontaneous losses and failures of two McDonald purse-string cerclages, underwent a transabdominal cervico-isthmic cerclage (TCC). She became pregnant 17 months after TCC. At 35 weeks of gestation, she was admitted to our hospital due to preterm labor and delivered a healthy female baby (2270 g) by cesarean section. After delivery of the newborn infant, we found a migration of about one third of the cerclage band into the endocervical canal. Two years later, she had one further pregnancy, reached 33 weeks of gestation, and delivered a 1450 g male baby by cesarean section due to a preterm labor without any signs of infection. Although it could have been a case of pure coincidence, we take a chance to speculate that the migration of the cerclage band into the endocervical canal might have been the reason for the preterm labor, and it must have been removed at her first cesarean section and replaced by a new cerclage band for her next pregnancy.

Successful Interval Laparoscopic Transabdominal Cervicoisthmic Cerclage Preceding Twin Gestation. Report of a Case

Study Objective: To report the case of a patient who underwent interval laparoscopic transabdominal cervicoisthmic cerclage after a previous failed transvaginal emergency cerclage performed in the second trimester. Minor modifications of the previously reported techniques are highlighted.

Successful Interval Laparoscopic Transabdominal Cervicoisthmic Cerclage Preceding Twin Gestation: A Case Report

Laparoscopic transabdominal cervicoisthmic cerclage (LTCC) is an alternative, less-morbid option to the traditional transabdominal cerclage, indicated for patients with cervical incompetence. Experience with the technique is based on case reports and a few case series. Considering LTCC for twin gestations, reports are very scarce and are derived from LTCC performed during pregnancy. We report the case of a 36-year-old patient, gravida 1, para 0, aborta 1, who underwent interval LTCC after a previous failed transvaginal emergency cerclage performed in the second trimester. Hysteroscopic metroplasty was concomitantly performed for an incomplete septate uterus. The procedure lasted 100 minutes, with an estimated blood loss of 50 mL. The patient was discharged home on the second postoperative day. The patient became pregnant with twins 3 months after the procedure after undergoing in vitro fertilization. The gestational course was uneventful, and the patient delivered 2 healthy neonates at 38 weeks gestation by elective cesarean section. The cerclage tape was left in situ. Minor modifications of the previously reported techniques included use of a laparoscopic Deschamps needle for placing the cotton cardiac tape used as suture material. Vessels in the cervical transverse cervical ligament were exposed before cerclage tape application. To our knowledge, this is the first report of interval LTCC preceding a twin gestation.

Évaluation du cerclage isthmique par voie cœlioscopique

Objective The transabdominal cervico-isthmic cerclage could to be proposed in case of failure of vaginal cerclage, 2nd trimester fetal losses and cervical defects. The efficiency of the laparoscopic approach, more recently described, has to be demonstrated for the prevention of obstetrical accident. Patients and methods This study is a retrospective monocentric evaluation of 14 laparoscopic cervico-isthmic cerclages performed with Benson modified technique before pregnancy between 2005 and 2007. Previous obstetrical accidents, etiology of cervical incompetence and patient outcome after cerclage were compared. Results Median age of the patients was 33.5 years; 93% had previous fetal losses or preterm delivery and 42.9% had failure of Mac Donald cerclages. The indication of laparoscopic cervico-isthmic cerclage was Mac Donald cerclage failure (six cases), and eight cases of anatomic incompatibility of Mac Donald cerclage. Mean duration of laparoscopic cervico-isthmic cerclage was 45 minutes. All patients were hospitalized on an outpatient basis. No operative complication was reported. Six women were pregnant after cerclage: five deliveries by caesarean section at term, and one first trimester foetal loss. Discussion and conclusion The cervico-isthmic cerclage can be easily performed by laparoscopy. The indications are strictly the same as cervico-isthmic cerclages by laparotomy. Increasing the number of term deliveries and the obstetrical outcome of these patients, the efficiency of the cervico-isthmic cerclage by laparoscopy is demonstrated.

Robotic-assisted laparoscopic cerclage in a pregnant patient

A robotic-assisted laparoscopic technique for transabdominal cerclage placement could offer improvements over the traditional laparoscopic approach. A gravid female with no vaginal portion of the cervix underwent a robotic-assisted laparoscopic cerclage at 12 weeks' gestation and ultimately delivered a healthy infant at term.

Experience with laparoscopic transabdominal cervico‐isthmic cerclage

Australian and New Zealand Journal of Obstetrics and GynaecologyVolume 48, Issue 4 p. 448-448 Experience with laparoscopic transabdominal cervico-isthmic cerclage P. SHEEHAN, P. SHEEHAN Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorA. ADES, A. ADES Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorR. PALMA-DIAS, R. PALMA-DIAS Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this author P. SHEEHAN, P. SHEEHAN Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorA. ADES, A. ADES Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this authorR. PALMA-DIAS, R. PALMA-DIAS Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Melbourne, AustraliaSearch for more papers by this author First published: 29 August 2008 https://doi.org/10.1111/j.1479-828X.2008.00899.xCitations: 1 DOI: 10.1111/j.1479-828X.2008.00899.x Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume48, Issue4August 2008Pages 448-448 RelatedInformation

Laparoscopic transabdominal cervico‐isthmic cerclage: A minimally invasive approach

While the traditional approach to management of cervical insufficiency has been the insertion of a transvaginal cerclage during pregnancy, a transabdominal cervico-isthmic suture is indicated in certain patients. This procedure is traditionally performed via laparotomy. Laparoscopic transabdominal cervico-isthmic cerclage (LTCC) placement, however, confers the benefit of the low morbidity associated with laparoscopy. To describe the technique and outcomes of LTCC in three cases. LTCC was performed using Mersilene tape at the level of the internal cervical os in the prepregnancy period in three patients: one with previous cervical amputation and two with previous failed cervical cerclage. Procedures were performed at a tertiary level endoscopic unit, Sydney, Australia. The laparoscopic approach enabled placement of a suture with no morbidity, and rapid patient recovery in these cases. Laparoscopic cervical cerclage proved technically feasible and safe for a surgeon trained in laparoscopic suturing methods.

Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage

The outcome of vaginal radical trachelectomy (VRT) for the management of early cervical cancer is comparable to that achieved with radical hysterectomy. Although VRT preserves the potential for pregnancy, the outcome of twin pregnancies following VRT is poor. We report a successful twin pregnancy after VRT using transabdominal cervicoisthmic cerclage.

Cerclage par voie abdominale pour la prise en charge des incompétences cervicales chez les femmes à haut risque

Transabdominal cervico-isthmic cerclage is an alternative to vaginal route for patients with severe cervical incompetence. The purpose of this study is to describe our experience with this technique during pregnancy for high risk women. We performed a retrospective study including 12 transabdominal cerclages performed between 1988 and 2005. All patients had an history of repeated midtrimester fetal losses or preterm delivery, and 82% already had a prior failed transvaginal cerclage. Fourteen pregnancies were reported. The median gestational age at cerclage placement was 14 weeks (range: 12 to 17). All patients underwent a caesarean section at a mean gestational age of 35 weeks gestation (range: 23 to 38 WG). The fetal survival rate was 93 compared to 17% before the cerclage. There were no significant perioperative or neonatal complications. Transabdominal cervico-isthmic cerclage remains a reliable technique for the management of cervical incompetence after a prior failed transvaginal cerclage when vaginal access is difficult. Laparoscopic approach is under development.