Emergency Cervical Cerclage Using Shirodkar Method / 대한산부인과학회잡지

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.

Emergency Cervical Cerclage Using Shirodkar Method / 대한산부인과학회잡지

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.

A clinical study on the incomptent internal os of the cervix / 대한산부인과학회잡지

OBJECTIVE: This study was performed to evaluate the effect of cervical cerclage and the clinical characteristics in incompetent internal os of the cervix (IIOC). METHODS: A study was conducted on 170 patients with IIOC, 199 cases of IIOC were admitted and treated with McDonald operation or modified Shirodkar operation at department of Obstetrics and Gynecology Il Sin Christian Hospital from January 1. 1994 to December 31. 1998, of this 14 cases were follow up lost, so 185 cases were analyzed. RESULTS: 1) The incidence of IIOC was 0.43%, 1 in 233 deliveries. 2) The mean age of IIOC patients was 30.54yrs old and the most frequent age group was in 30-34yrs old group (43.78%). 3) The average number of gravida and parity before operation were 4.71 and 1.62. & the success rate of operation was low at high gravida & parity. 4) The predisposing factor was previous history of dilation & curettage (43.75%), Cx. laceration after delivery (6.49%), midtrimester termination (4.32%) etc. 5) The operation methods were McDonald operation (91.35%) and modified Shirodkar operation (8.65%) & the success rate of McDonald operation and modified Shirodkar operation were 85.80% and 87.50%. 6) The successful fetal salvage rate was 85.95% and the highest success rate was 87.50% in 14-16 weeks of gestation group. 7) The more cervix dilate, the more failure occurred. 8) The causes of operation failure were premature rupture of membrane (50.00%), preterm labor (34.62%), FDIU, anomaly, APH etc. 9) The delivery methods after operation were vaginal delivery (65.54%), cesarean delivery (34.46%). CONCLUSION: The 14-16th weeks of gestation group & no cervical dilatation have higher success rate indicating that early diagnosis and appropriate timing of operation is associated with a greater operation success rate.