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Preterm Birth Prevention In Asymptomatic Women
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
The other clinical indication for history-indicated cerclage might include CI, defined by some as prior painless cervical dilatation leading to recurrent STLs. Unfortunately, no trial has been done to confirm the efficacy of history-indicated cerclage in reducing PTB in women with a diagnosis of CI. Other indications such as prior cone biopsy, Mullerian anomaly, diethylstilbestrol (DES) exposure, prior PTB not associated with CI, and Ehlers-Danlos syndrome have occasionally been used clinically but have not been confirmed by any trial as indications that benefit from history-indicated cerclage. History-indicated cerclage is usually performed at 12–15 weeks’ gestation, and its techniques have been well described [73].
Cervical insufficiency
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Sonia S. Hassan, Roberto Romero, Francesca Gotsch, Lorraine Nikita, Tinnakorn Chaiworapongsa
Cervical cerclage was introduced in 1955 by V. N. Shirodkar, Professor of Midwifery and Gynecology at the Grant Medical College in Bombay, India (39). The procedure was developed in response to his observation that “some women abort repeatedly between the fourth and seventh months and no amount of rest and treatment with hormones seemed to help them in retaining the product of conception” (39). Shirodkar referred to a group of 30 women who had had at least four abortions (some between 9 and 11 weeks). He stated that in his opinion, “95% of cases were due to a weak cervical sphincter and the other few to an underdeveloped or malformed uterus, etc” (39). Shirodkar emphasized that his work was confined to women in whom he could prove the existence of weakness of the internal os by “repeated internal examinations” (39). Ian McDonald, from the Royal Melbourne Hospital, reported in 1957 his experience with 70 patients who had a suture of the cervix for inevitable miscarriage (40). The history of this procedure is relevant since 50 years after its introduction: cerclage is being used for indications different from those originally intended, and there is conflicting evidence about its efficacy for the new indications (e.g., prevention of preterm birth in women with a sonographic short cervix) (39,40,90–92,95–97,133–154).
Rescue cerclage
Published in Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves, Clinical Protocols in Labour, 2020
Michael S. Marsch, Janet M. Rennie, Phillipa A. Groves
Rescue cerclage is performed between 18 and 26 weeks’ gestation. the technique in this high-risk situation is difficult and should not be attempted by doctors unfamiliar with the method. the decision should be discussed with the consultant on call.
Impact of prolonged use of adjuvant tocolytics after cervical cerclage on late abortion and premature delivery
Published in Journal of Obstetrics and Gynaecology, 2023
Li-Rong Zhao, Shu-Jing Lu, Qing Liu, Ying-Chun Yu, Li Xiao
Spontaneous abortion and premature delivery are major concerns for both obstetricians and pregnant women. Preterm birth affects approximately 10% of pregnancies (Pohl et al. 2018). The reasons for late abortion and premature deliveries could be multifactorial (Goldenberg et al. 2008). Cervical insufficiency is one of the causes of late abortion and premature delivery. A study has shown that acute cervical insufficiency accounts for 10–25% of all mid-trimester pregnancy losses (Park et al. 2021). Cervical cerclage was first performed to treat cervical insufficiency in 1955, and has subsequently become the most commonly performed surgical procedure to prolong the pregnancy time in patients with the loss and premature delivery of second pregnancy caused by cervical insufficiency. Zhu LQ et al. (Zhu et al. 2015) mentioned that cervical cerclage was a feasible choice to prolong the pregnancy. However, cervical cerclage of patients with uterine contractions may lead to abortion and premature delivery. Therefore, we retrospectively analysed the medical data at our hospital to examine the impact of persistent uterine contraction inhibition after cervical cerclage on late abortion and premature delivery.
Effect of Surgical Adhesive on the Uterus of Rabbits Following Occlusion
Published in Journal of Investigative Surgery, 2019
Anran Xu, Tianyu Hao, Xiaoqing Wei, Chuanfen Li, Lihua Niu, Xiaohui Deng
Hysterosalpingography was performed on the experimental rabbits at 1 or 6 months after surgery to evaluate the uterine occlusion. Following anesthesia, the rabbit was fixed on the fluoroscopy stretcher in supine position, followed by disinfection of the vulva and vaginal and abdominal skin by iodine. Next, the outer labia was ventrally pulled, and then an artificial insemination catheter lubricated with a sterile lubricating jelly was inserted through the introitus and into the vagina at a depth of 3–4 cm. The abdominal cavity was subsequently opened in order to observe the catheter through the wall of the vagina and further insert it into the cervix. The distal end of the catheter was then inserted into the uterus. Subsequently, cervical cerclage was performed on the outer edge of the uterus with absorbable suture to prevent catheter shedding. The same procedure was performed on the other uterine cavity. After connecting the proximal end of the catheter to the push and injection device for hysterosalpingography, the operator supervised the injection of the rabbit with 76% meglumine diatrizoate (Hunan Hansen Pharmaceutical Co., Ltd., Yiyang, China) until the uterus image was fully developed. Following video- and photo-recording, the abdominal cavity was closed, and the rabbits were provided with routine postoperative anti-infection treatments.
A ten year review of time interval between elective cervical cerclage removal at term and spontaneous onset of labour in Enugu, South-East Nigeria
Published in Journal of Obstetrics and Gynaecology, 2021
Vivian Adaeze Ndubuisi, Euzebus Chinonye Ezugwu, Chukwuemeka Iyoke
Cervical cerclage insertion is used in management of women with cervical insufficiency. It is a surgical procedure in which sutures are positioned around the cervix in order to provide mechanical support to the cervix and keep it closed to the end of the pregnancy. Cerclage insertion may be inserted in the first trimester or early second trimester (13–16 weeks) when there is a clinical history suggesting a risk of mid trimester pregnancy loss, or when there is evidence of short cervix or cervical shortening on ultrasound (Liddiard et al. 2011; Surrette and Dunhan 2013; Bukar et al. 2014). Cerclage is usually removed at 37 completed weeks and the woman allowed to go into spontaneous labour (Dimejesi and Onwe 2017).