Delayed-Interval Delivery after Cerclage Operation in a Case of Twin Pregnancy with One Fetal Delivery / 대한산부인과학회지

With delayed childbearing and increased use of ovulation-stimulating drugs and assisted reproductive technologies (ART), the incidence of multiple pregnancies has increased dramatically in the past 20 years. One of the most common and serious complications of multiple pregnancies is preterm delivery. The delivery of the initial fetus in a multiple gestation usually is followed by the delivery of the subsequent fetus or fetuses shortly there after. However, a few successful delayed-interval deliveries have been reported since the first case in 1880 by Carson. Since that time, an interest in delayed-interval delivery has been developed and spurred by the increased prevalence of multiple gestations and preterm deliveries associated with these pregnancies. We report a case of a delayed-interval delivery in a twin pregnancy with an interval of 71 days. This case is the longest interval case and the fisrt delayed-interval delivery in monochorionic twin in Korea.

Validity of Indications and Clinical Outcome of Transabdominal Cervicoisthmic Cerclage for Cervical Incompetence / 대한주산의학회잡지

OBJECTIVES: The purpose of this study was to review the indications of transabdominal cervicoisthmic cerclage and clinical outcome to determine whether it is a valid alternative to transvaginal cerclage. METHODS: A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to Dec. 2004. Analysis of the indications for the transabdominal rather than the vaginal approach and evaluation of fetal outcomes was performed. RESULTS: 48 patients underwent transabdominal cerclage. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 23 patients, the secondary indication was short cervix for transvaginal cerclage in 19 patients and cervical laceration in 6 patients. In 48 pregnancies, 8 twins were included. Therefore, total number of fetus was 56. One fetus of twin died in uterus at 27 weeks of gestation with unknown cause. 48 patients successfully delivered 55 live babies by Cesarean section. However, three babies died due to Tetralogy of Fallot, gastroschisis and preterm delivery. Complication including blood loss requiring transfusion did not occur. All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Live birth rate was 92% (52/56), compared with 28% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. CONCLUSIONS: Our results and review of literature confirm that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.

Experiences of Amnioreduction and Emergency Cerclage for Advanced Cervical Incompetence / 대한산부인과학회잡지

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.

The Usefulness in the Value of Some Infectious Parameters to Predict the Success of Emergency Cervical Cerclage Operation / 대한산부인과학회잡지

OBJECTIVE: To predict the perinatal outcomes of emergency cervical cerclage operation we analyzed some infectious parameters before and after the operation in patients has incompetent internal os of cervix, and compared their results between one success group and one failed group. METHODS: The 13 patients with emergency cervical cerclage and the 31 patients with elective cervical cerclage included in our study. After emergency cerclage, we investigated some infectious parameters as ESR, CRP, and WBC count, every other day. And we compared these values between success and failed group. We also evaluated the difference of these results between emergency cerclage and elective cerclage operation. RESULTS: 1. There were higher values of ESR and CRP after cerclage operation in failed group than those in success group significantly (p<0.05). 2. There also had shown higher values of WBC count at 3 days after operation in failed group than those in success group significantly (p<0.05). CONCLUSION: The infection is one of the most important factors in successful perinatal outcome after emergency cerclage operation and continuous follow up in ESR, CRP and WBC counts after operation can be used to predict the perinatal outcomes in relation to incompetent internal os of cervix.

A Clinical Study on the Incompetent Internal Os of the Cervix / 대한산부인과학회잡지

OBJECTIVE:Our goal was to evaluate the clinical characteristics and statistical analysis in incompetent internal os of the cervix(IIOC) METHOD: At Department of Obstetrics and Gynecology, Eulgi Hospital and Eulgi university Hospital from January 1, 1991 to December 31, 1997, 296 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation. Of this, 38cases were follow up lost, so 252 cases were analayzed. Diagnostic criteria was previous history of painless cervical dilatation, followed by spontaneous abortion or preterm birth, and acceptance without resistance at the internal os of No. 8 Hegar dilator. RESULT: Incidence of IIOC was 1.61%, 1 in 60 deliveries. Most frequent age group was in 28-30 years old group and mean age was 30 years old. Total number and mean number of gravida was 818 and 3.2. The most common contributing factor was previous artificial abortion(77%), and cervix dilatation(9%), old cervical laceration(4.3%) etc, was followed. Operation methods were McDonald operation(56%) and modified Shirodkar operation(44%). The Success rate of McDonald and modified Shirodkar was 78.1% and 88.1%. Successful fetal salvage rate was 82.5%, and the highest success rate was 86.9% in 14-18th weeks of gestation group. The more cervix dilate, the more failure occured. Causes of operation failure was premature rupture of membrane(54.5%), preterm labor(43.2%) and fetal death in utero(2.3%). Delivery method after operation was vaginal delivery(146cases, 70.9%) and cesarean delivery(60cases, 29.1%). Cause of cesarean delivery was previous cesarean section(43.3%), breech presentation(16.7%), cephalopelvic disproportion(15%), prolonged labor(6.7%), fetal disttess(6.7%), twin(5%), placenta previa(3,3%) and abruptio placenta(3.3%). CONCLUSION: The 14-18th weeks of gestation group & no cervical dilatation group has higher success rate, which indicate early diagnosis and appropriate timing of operation is probably associated with a greater operation