Transabdominal cervicoisthmic cerclage during pregnancy: The strength of cerclage band and the pregnancy outcomes / 대한산부인과학회잡지

BACKGROUND/OBJECTIVE: After introducing transabdominal approach of cervical cerclage since 1965, several authors have reported significant increases in fetal survival rate. However, this procedure has not been widely used because its complexity of procedure and serious complications. Furthermore, there is a dilemma on the strength of the cerclage bands knots. Yet, there is no standard guidance in this approach. The purpose of this study was to suggest degree of adequate tension on the knot when tying the cerclage band on the cervico-isthmic junction during post-conceptional transabdominal cerclage and to assess whether the strength of the band is associated with uterine blood flow or pregnancy outcomes. STUDY DESIGN: Sixty-five transabdominal cervico-isthmic cerclages during pregnancy were performed for 7 years since 1989 in patients of incompetent cervix who could not be taken transvaginal cerclage. The procedures were performed with our own technique, modified technique from original Novys procedure. The cerclage used a 5mm-Mersilene band and knot was placed on the anterior side. Pre- and post-operative uterine blood flow were evaluated with Doppler velocimetry. After cesarean section at term, cerclage bands were removed and collected for measurement of bands length if they do not want further pregnancies. The relationships between strength of cerclage, length of band and pregnancy outcomes were evaluated. The effects of the bands length on the uterine blood flow were also analyzed. RESULTS: To date there have been 56 completed pregnancies in 50 patients. Among these, 21 cerclage bands were removed and collected for measurement of bands length. All pregnancies (27 pregnancies from 21 patients) were successful; the average gestational age at delivery was 38.4 weeks (range: 37-43) and mean birth weight was 3178gm (range:2670-4370). Average length of cerclage bands was 7.01cm(range:5.0-9.4), thus diameter of cerclage bands was calculated as 2.2cm. Statistically, significant positive correlation was found between the bands' length and birth weights (r=0.614, p=0.002). There were no differences between pre- and post-operative uterine blood flow regardless of cerclage bands length. CONCLUSIONS: We suggest 7cm is adequate bands length when performing transabdominal cerclage during pregnancy. Uterine blood flow was not influenced by operation. It was interesting that bands length was correlated with birth weight. It seems that tightened cerclage might preclude the adequate formation of lower uterine segment during pregnancy. Recently we use the specific Mersilene bands after marking of each centimeter interval on it, and bands are tied with 7cm in length for adequate strength of the cerclage. We propose this result also could be used when performing the pre-conceptional transabdominal cerclage.

Management of Incompetent Cervix and Bulging Fetal Membrane by Modified Shirodkar Method / 대한산부인과학회잡지

Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.

Study on Pregnancy Outcomes after Transabdominal Cervico-Isthmic Cerclage before Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to evaluate the effect of transabdominal cervicoisthmic cerclage before pregnancy among the patients who had poor obstetric outcome from previous failed transvaginal cervical cerclage and/or an anatomically defective cervix. STUDY DESIGN: A retrospective review of pre-conceptional transabdominal cervicoisthmic cerclage patients was conducted at Hanyang University Medical Center from 1989 to 1997, and analysis of the pregnancy outcomes after preconceptional transabdominal cervicoisthmic cerclage operation. RESULTS: The fifteen patients had 11 successful pregnancy outcomes. Two patients had two consecutive succesful pregnancies and repeat cesarean section deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage before pregnancy offers a high rate of fetal salvage with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.

Study on Pregnancy Outcomes after Transabdominal Cervico-Isthmic Cerclage during Pregnancy / 대한산부인과학회잡지

OBJECTIVE: Transabdominal cervico-isthmic cerclage(TCIC) may increase the fetal salvage rate and pregnancy outcome in selected women when poor obstetric outcome is related to previously failed transvaginal cervical cerclage and an anatomically defective cervix. Our purpose was to evaluate the outcomes after transabdominal cervicoisthmic cerclage during pregnancy. STUDY DESIGN: A retrospective review was done from patients who had been received transabdominal cervicoisthmic cerclage during pregnancy at Hanyang University Medical Center from October, 1989 to April 1997. The fetal salvage rate before and after post-conceptional transabdominal cervicoisthmic cerclage were compared and analysed. RESULTS: The seventy-eight patients had 95 successful pregnancies out of a total of 97. Thus the fetal salvage rate of TCIC during in pregnancy was 97.9 %. Of 78 patients, nineteen patients had the second succesful pregnancies and repeat cesarean deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage during pregnancy offers a high fetal salvage rate with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.