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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
There are several approaches to cervical cerclage: (i) the Shirodkar method (39), (ii) the McDonald method (40), (iii) the Wurm procedure (155), and (iv) transabdominal (156). The latter has been performed using a laparotomy approach and later described, laparoscopically (157,158). The most widely used procedure is the McDonald cerclage.
Investigations, treatment and management
Published in Janetta Bensouilah, Pregnancy Loss, 2021
Ideally, measurements are taken serially during the second and early third trimesters, although a single measurement in the second trimester is sometimes offered. Cervical cerclage, which involves the insertion of a stitch, or suture, is the mainstay of treatment of cervical incompetence, and is performed either at around 12–14 weeks or later as an emergency measure. Debate over whether prophylactic cervical cerclage has real benefits for the majority of women who undergo the procedure is ongoing. It is known that for every 25 cerclages that are inserted, one woman will benefit. The procedure is not without risk, and is performed either transvaginally or (less commonly) transabdominally. In both cases the patient is required to have complete rest during recovery, which takes several weeks. Undoubtedly some women undergo what is quite a major intervention unnecessarily, but on the other hand the procedure serves a real purpose in reassuring women that their pregnancy will continue successfully, and the psychological benefits of this alone can be immense.
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
Surgical intervention for uterine malformations remains poorly supported by randomized controlled trials (Table 12.3). It is generally agreed that adhesions, polyps, and protruding submucous myomas should be hysteroscopically resected. However, the need for hysteroscopic division of a uterine septum remains debatable but may be indicated in a patient with two or more pregnancy losses. Abdominal metroplasty for the bicornuate uteri is even more difficult to support in light of its significant associated morbidity and lack of controlled data. Abdominal metroplasty is currently recommended only in selected rare cases with recurrent severe problems in the second and third trimesters. Cervical cerclage is only indicated in women with uterine anomalies in the presence of a clinical diagnosis of cervical incompetence or additional risk factors. In women with hydrosalpinges and early recurrent miscarriage, laparoscopic salpingectomy or proximal tubal occlusion should be considered.
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.
Perinatal outcomes of twin emergency cerclage: comparison with expectant treatment and singleton emergency cerclage
Published in Journal of Obstetrics and Gynaecology, 2023
Yuanfan Lu, Jing Zhu, Xiaoting Yu, Zhenyao Li, Tong Zhou, Jiajia Chen, Xianping Huang, Huiqiu Xiang, Jiale Bao, Zhangye Xu
The sudden dilation of the cervix in the mid-trimester leads to adverse pregnancy outcomes, such as abortion and premature delivery. The clinal decision-making process during pregnancy can be complex, especially in the presence of twin pregnancies. This must balance perinatal risks, pros and cons of cervical cerclage vs. expectant treatment, and the patient’s values and preferences. Emergency cervical cerclage for a dilated cervix with exposed membranes is effective in singleton pregnancies. In twin pregnancies, several studies also suggested a beneficial effect of emergency cervical cerclage in pregnancy prolongation and neonatal survival. Studies have reported prolongation of pregnancy by 4.4–13 weeks following rescue cerclage, and the neonatal survival rate was 50–83.3% (Rebarber et al.2014, Abbasi et al.2018, Chun et al.2018, Park et al.2018). The present findings were also encouraging, with the median interval to delivery being ∼37 days and the neonatal survival rate being 75%.
A retrospective cohort study of obstetric complications and birth outcomes in women with polycystic ovarian syndrome
Published in Journal of Obstetrics and Gynaecology, 2022
Qiwei Liu, Jingxue Wang, Qian Xu, Liang Kong, Jinjuan Wang
Chorioamnionitis was defined by 2 or more clinical signs of infection, including maternal pyrexia, tachycardia, uterine tenderness, offensive liquor and foetal tachycardia (Stojanovska et al. 2018). Cervical incompetence was diagnosed based on clinical symptoms and ultrasound results (Wang et al. 2016). The definition of cervical incompetence incorporates both a sonographic cervical length of less than 25 mm and prior spontaneous preterm birth at less than 37 weeks. The traditional management of cervical incompetence is application of transvaginal cervical cerclage. Non-invasive management options also exist, including progesterone therapy and cervical pessary, which may be effective management options. The diagnosis of preterm birth is defined as <37 weeks of gestation (Leonard et al. 2015).