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Qin F, Yang Y, Zhou W, Chi Y, Liu B, Chen G. Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage. Arch Gynecol Obstet 2024; 309:1377-1386. [PMID: 37004539 PMCID: PMC10894100 DOI: 10.1007/s00404-023-07007-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome. METHODS A total of 53 cases by laparoscopic abdominal cervical cerclage (LAC group) before pregnancy and 73 cases by transvaginal cervix cerclage (TVC group) at 12-14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. Furthermore, the gestational weeks after cervical cerclage were compared between the two groups with high- and low-risk grades. RESULTS The number of previous uterine cavity operations in LAC group was more than that TVC group, and the costs of operation were more than TVC group. At the same time, the hospitalization days and operation time were longer than those in TVC group, and the delivery rate of cesarean section was higher than TVC group, but the total hospitalization times were less than TVC group (P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in LAC group were lower than those in TVC group (P < 0.05). In TVC group, the increased number of prior PTB or STL and the history of cervical cerclage failure would increase the risk of premature delivery before 34 weeks of pregnancy. There was no increased risk of preterm delivery before 34 weeks of pregnancy in LAC group (P > 0.05). According to the risk level, in the high-risk group, the delivery rate of LAC group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of TVC group. CONCLUSION Laparoscopic cervical cerclage might be more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks was not affected by related medical history. For high-risk patients with the history of prior PTB or STL and failed cerclage, laparoscopic cervical cerclage might be more effective than vaginal cervical cerclage in preventing extremely preterm before 28 weeks, premature delivery before 34 weeks and premature delivery before 37 weeks. Therefore, our limited experience suggested that LAC can be a recommended option for patients with high-risk history.
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Affiliation(s)
- Feng Qin
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Yong Yang
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Wei Zhou
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Yugang Chi
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Bao Liu
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Gongli Chen
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China.
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Abdulrahman N, Burger NB, Hehenkamp WJK, Maghsoudlou P, Einarsson JI, Huirne JAF. Favorable surgical and obstetrical outcomes in pre- and postconceptional laparoscopic abdominal cerclage: a large multicenter cohort study. Am J Obstet Gynecol MFM 2024; 6:101227. [PMID: 37984689 DOI: 10.1016/j.ajogmf.2023.101227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/04/2023] [Accepted: 11/15/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Cervical incompetence is an important cause of extremely preterm delivery. Without specialized treatment, cervical incompetence has a 30% chance of recurrence in a subsequent pregnancy. Recently, the first randomized controlled trial showed significant superiority of abdominal cerclage compared with both high and low vaginal cerclage in preventing preterm delivery at <32 weeks of gestation and fetal loss in patients with a previous failed vaginal cerclage. OBJECTIVE This study aimed to assess surgical and obstetrical outcomes in patients with pre- and postconceptional laparoscopic abdominal cerclage placement. Furthermore, it also aimed to perform subgroup analysis based on the indication for cerclage placement in order to identify patients who benefit the most from an abdominal cerclage. STUDY DESIGN A retrospective multicenter cohort study with consecutive inclusion of all eligible patients from 1997 onward in the Dutch cohort (104 patients) and from 2007 onward in the Boston cohort (169 patients) was conducted. Eligible patients had at least 1 second- or third-trimester fetal loss due to cervical incompetence and/or a short or absent cervix after cervical surgery. This includes loop electrosurgical excision procedure, conization, or trachelectomy. Patients were divided into the following subgroups based on the indication for cerclage placement: (1) previous failed vaginal cerclage, (2) previous cervical surgery, and (3) other indications. The third group consisted of patients with a history of multiple second- or early third-trimester fetal losses due to cervical incompetence (without a failed vaginal cerclage) and/or multiple dilation and curettage procedures. The primary outcome measure was delivery at ≥34 weeks of gestation with neonatal survival at hospital discharge. Secondary outcome measures included surgical and obstetrical outcomes, such as pregnancy rates after preconceptional surgery, obstetrical complications, and fetal survival rates. RESULTS A total of 273 patients were included (250 in the preconceptional and 23 in the postconceptional cohort). Surgical outcomes of 273 patients were favorable, with 6 minor complications (2.2%). In the postconceptional cohort, 1 patient (0.4%) had hemorrhage of 650 mL, resulting in conversion to laparotomy. After preconceptional laparoscopic abdominal cerclage (n=250), the pregnancy rate was 74.1% (n=137) with a minimal follow-up of 12 months. Delivery at ³34 weeks of gestation occurred in 90.5% of all ongoing pregnancies. Four patients (3.3%) had a second-trimester fetal loss. The indication for cerclage in all 4 patients was a previous failed vaginal cerclage. The other subgroups showed fetal survival rates of 100% in ongoing pregnancies, with a total fetal survival rate of 96%. After postconceptional placement, 94.1% of all patients with an ongoing pregnancy delivered at ³34 weeks of gestation, with a total fetal survival rate of 100%. Thus, second-trimester fetal losses did not occur in this group. CONCLUSION Pre- and postconceptional laparoscopic abdominal cerclage is a safe procedure with favorable obstetrical outcomes in patients with increased risk of cervical incompetence. All subgroups showed high fetal survival rates. Second-trimester fetal loss only occurred in the group of patients with a cerclage placed for the indication of previous failed vaginal cerclage, but was nevertheless rare even in this group.
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Affiliation(s)
- Nour Abdulrahman
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne).
| | - Nicole B Burger
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
| | - Parmida Maghsoudlou
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Ms Maghsoudlou and Dr Einarsson)
| | - Jon I Einarsson
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA (Ms Maghsoudlou and Dr Einarsson)
| | - Judith A F Huirne
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne, Ms Maghsoudlou); Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands (Drs Abdulrahman, Burger, Hehenkamp, and Huirne)
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Sodhi M, Gupta P, Kriplani I, Kriplani A. Laparoscopic Cerclage in a Case of Unicornuate Uterus with Cervical Insufficiency and Previous Failed Mc Donald Cerclage with a Successful Outcome: A Case Report. J Obstet Gynaecol India 2023; 73:268-270. [PMID: 38143987 PMCID: PMC10746642 DOI: 10.1007/s13224-023-01798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 06/16/2023] [Indexed: 12/26/2023] Open
Abstract
In this report, we describe a 28-year-old woman, with unicornuate uterus and multiple mid-trimester losses, with two failed Mc Donald's cerclage. She presented to us as a case of recurrent pregnancy losses with history suggestive of cervical incompetence and on detailed investigation was found to be ANA and anti-cardiolipin antibody positive and Rh negative. We performed an interval laparoscopic cervical cerclage for her and were able to successfully deliver her at 35 + 3 weeks with a healthy baby by caesarean section after previous five pregnancy losses and two failed Mc Donald's cerclage. Cervical cerclage can be used as an effective method of preventing abortions in unicornuate uterus pregnancy, while laparoscopic cerclage would be a better choice for patients with cervical incompetence with previous failed Mc Donald's cerclage. The possibility of uterine rupture for these high-risk patients should be kept in mind and decision to deliver at appropriate period of gestation so as to avoid uterine rupture and prematurity should be taken.
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Affiliation(s)
- Manpreet Sodhi
- Consultant Obstetrics and Gynecology and ART, Paras Hospita, Gurugram, India
| | - Prachi Gupta
- Associate Consultant, Obstetrics and Gynecology and ART, Paras Hospital, Gurugram, India
| | - Isha Kriplani
- Associate Consultant, Obstetrics and Gynecology and ART, Paras Hospital, Gurugram, India
| | - Alka Kriplani
- Director and Head, Minimally Invasive Gynecology, Obstetrics and ART Paras Hospital, Gurugram, India
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Hulshoff CC, Hofstede A, Inthout J, Scholten RR, Spaanderman MEA, Wollaars H, van Drongelen J. The effectiveness of transabdominal cerclage placement via laparoscopy or laparotomy: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100757. [PMID: 36179967 DOI: 10.1016/j.ajogmf.2022.100757] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Failure or technical impossibility to place a prophylactic transvaginal cerclage in women with cervical insufficiency justifies the need for an abdominal cerclage. In this systematic review and meta-analysis, we studied the obstetrical and surgical outcomes of laparoscopic and open laparotomy abdominal cerclage approaches performed before (interval) or during pregnancy. DATA SOURCES We performed a systematic literature search in PubMed, Embase, and the Cochrane Library for studies on laparoscopic and open laparotomy abdominal cerclage placement in February 2022. STUDY ELIGIBILITY CRITERIA All studies on laparoscopic or open laparotomy placement of an abdominal cerclage with at least 2 patients that reported on our primary outcomes were included. METHODS All included studies were assessed for quality and risk of bias with an adjusted Quality in Prognosis Study tool. Random effects meta-analyses were performed for the primary outcomes, namely fetal survival and gestational age at delivery. RESULTS Our search yielded 83 studies with a total of 3398 patients; 1869 of those underwent laparoscopic cerclage placement and 1529 underwent open laparotomy placements. No studies directly compared the 2 cerclage approaches. The survival (overall, 91.2%) and gestational age at delivery (overall, 36.6 weeks) were not statistically different between the approaches. For the procedure during pregnancy, the laparoscopic group showed significantly less blood loss >400 mL (0% vs 3%), a slightly lower procedure-related fetal loss (0% vs 1%), a shorter hospital stay but a longer operation duration than the open laparotomy group. For the interval cerclages, the laparoscopic group showed significantly fewer wound infections (0% vs 3%) and a shorter hospital stay than the open laparotomy group, but showed comparable offspring preterm birth and survival rates. CONCLUSION Based on indirect comparisons, the laparoscopic and open laparotomy abdominal cerclage placements at interval or during pregnancy produced similar outcomes in terms of survival and gestational age at delivery. There are some small differences in perioperative care, surgical complications, interventions, and complications during pregnancy. This implies that both methods of abdominal cerclage placement have high success rates and thus we cannot conclude that one of the methods is superior for the placement of an abdominal cerclage.
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Affiliation(s)
- Cecile C Hulshoff
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen).
| | - Aniek Hofstede
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Joanna Inthout
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands (Dr Inthout)
| | - Ralph R Scholten
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Marc E A Spaanderman
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Hanna Wollaars
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
| | - Joris van Drongelen
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands (Drs Hulshoff, Hofstede, Scholten, Spaanderman, Wollaars, and Drongelen)
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Huang G, Deng C, Liao H, Hu Q, Yu H, Wang X. Comparison of transvaginal cervical cerclage versus laparoscopic abdominal cervical cerclage in cervical insufficiency: a retrospective study from a single centre. BMC Pregnancy Childbirth 2022; 22:773. [PMID: 36253759 PMCID: PMC9575299 DOI: 10.1186/s12884-022-05108-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/07/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cervical cerclage has been proposed as an effective treatment for cervical insufficiency, but there has been controversy regarding the surgical options of cervical cerclage in singleton and twin pregnancies. This study aimed to compare the pregnancy outcomes between transvaginal cervical cerclage (TVC) and laparoscopic abdominal cervical cerclage (LAC) in patients with cervical insufficiency. We also aimed to evaluate the efficacy and safety, and provide more evidence to support the application of cervical cerclage in twin pregnancies. Methods A retrospective study was carried out from January 2015 to December 2021. The primary outcomes were the incidence of spontaneous preterm birth (sPTB) < 24 weeks, < 28, < 32, < 34 weeks, and < 37weeks, gestational age at delivery, and the incidence of admission for threatened abortion or preterm birth after cervical cerclage. The secondary outcomes included admission to the Neonatal Intensive Care Unit, adverse neonatal outcomes and neonatal death. We also analysed the pregnancy outcomes of twin pregnancies after cervical cerclage. Results A total of 289 patients were identified as eligible for inclusion. The LAC group (n = 56) had a very low incidence of sPTB ˂ 34 weeks, and it was associated with a significant decrease in sPTB < 28 weeks, ˂32 weeks, ˂34 and < 37 weeks, and admission to the hospital during pregnancy for threatened abortion or preterm birth after cervical cerclage (0 vs.27%; 1.8% vs. 40.3%; 7.1% vs. 46.8%; 14% vs. 63.5%, 8.9% vs. 62.2%, respectively; P < 0.001), and high in gestational age at delivery compared with the TVC group (n = 233) (38.3 weeks vs.34.4 weeks,P < 0.001). Neonatal outcomes in the LAC group were significantly better than those in the TVC group. The mean gestational age at delivery was 34.3 ± 1.8 weeks, with a total foetal survival rate of 100% without serious neonatal complications in twin pregnancies with LAC. Conclusion In patients with cervical insufficiency, LAC appears to have better pregnancy outcomes than TVC. For some patients, LAC is a recommended option and may be selected as the first choice. Even in twin pregnancies, cervical cerclage can improve pregnancy outcomes with a longer latency period, especially in the LAC group. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05108-w.
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Affiliation(s)
- Guiqiong Huang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Chunyan Deng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Hua Liao
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Qing Hu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China
| | - Haiyan Yu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
| | - Xiaodong Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, No. 20, 3rd section, South Renmin Road, 610041, Sichuan, Chengdu, China. .,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, China.
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Analysis of the Timing of Cervical Cerclage Treatment in Pregnant Women with Cervical Insufficiency and the Effect on Pregnancy Outcome. Emerg Med Int 2022; 2022:8340009. [PMID: 35811604 PMCID: PMC9262559 DOI: 10.1155/2022/8340009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyze the effect of the choice of timing of cervical cerclage treatment on pregnancy outcome in pregnant women with cervical insufficiency (CI). Methods The case data of 160 pregnant women admitted to our hospital for cervical cerclage due to CI from January 2020 to September 2021 were sampled. They were divided into the early group (14∼18 weeks of pregnancy, n = 86), the middle group (19∼27 weeks of pregnancy, n = 74) according to the different gestational periods of surgical treatment, and into the elective group (elective operation, n = 71) and the emergency group (emergency operation, n = 89) according to the different timings of surgical treatment. To compare the pregnancy outcomes of the four groups and the effects of different treatment timings on pregnant women and newborns. Results After the operation, the intrauterine infection rate in the early group was lower (8.14% (7/86)) than that (71.62% (53/74)) in the middle group, and the intrauterine infection rate (18.31% (13/71)) in the elective group was lower (61.80% (55/89)) than that in the emergency group (P < 0.05). After the operation, the late abortion rate in the early group was 8.14% (7/86) lower than 63.51% (47/74) in the middle group, and the late abortion rate in the elective group was 15.49% (11/71) lower than 61.80% (55/89) in the emergency group (P < 0.05). After the operation, the full-term birth rate (82.56% (71/86)) in the early group was higher (21.62% (16/74)) than that in the middle group, and the full-term birth rate (73.24% (52/71)) of the elective group was higher (24.72% (22/89)) than that in the emergency group (P < 0.05). After the operation, there was no significant difference in the preterm birth rate between the early group and the middle group (8.14% vs 14.86%), and between the elective group and the emergency group (11.27% vs 12.36%) (P > 0.05). There was no significant difference in neonatal Apgar scores between the early group and the middle group (7.30 ± 0.98 vs 7.14 ± 0.91) scores, and between the selective group and the emergency group (7.15 ± 0.82 vs 7.07 ± 1.07) scores (P > 0.05). There was no significant difference in gestational week extension time between the early group and the middle group (6.52 ± 1.77 vs 6.99 ± 1.69) days and between the elective group and the emergency group (6.44 ± 1.37 vs 6.82 ± 1.70) days (P > 0.05). The length of hospital stay was (7.28 ± 1.39 vs 10.89 ± 2.65) days in the early group and the middle group, with the early group being shorter than the middle group (P < 0.05), and the length of hospital stay was (8.72 ± 1.23 vs 9.30 ± 1.39) days in the elective group and the emergency group, with the elective group being shorter than the emergency group (P < 0.05). Conclusions The therapeutic effect and pregnancy outcome of cervical cerclage are affected by the timing of treatment. Among them, the effect of elective operation at 14∼18 weeks of pregnancy is more ideal, which is worthy of clinical promotion.
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Cao T, Li J, Shen H. The comparative analysis of laparoscopic or transvaginal cerclage in pregnancies with cervical insufficiency: a retrospective cohort study. Arch Gynecol Obstet 2022; 307:1415-1422. [PMID: 35648226 DOI: 10.1007/s00404-022-06617-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/07/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of prophylactic cervical cerclage by laparoscopy in pregnant women versus transvaginal way. DESIGN Retrospective, monocentric cohort study was performed. SETTING The First Affiliated Hospital of Sun Yat-sen University. PATIENTS Cases with cervical insufficiency (defined by previous history of painless second or early third trimester pregnancy loss/losses) were selected. INTERVENTIONS Laparoscopic or transvaginal cerclage were conducted. The maternal information and the neonatal data were collected and compared. The pregnancy outcomes including the incidence of full-term labor and gestational weeks at delivery were defined as the primary outcomes. Neonatal survival and birth weight, neonatal complications were evaluated as the secondary outcomes. MEASUREMENTS AND MAIN RESULTS Totally 36 twin pregnant cases and 82 singleton pregnant cases were managed with cerclage, either trans-laparoscopy (totally 78 cases) or transvaginal (totally 40 cases). Demographic characteristics showed no significant differences. Cases in laparoscopic group had a prolonged gestational age at delivery (36.43 ± 0.93 weeks and 33.60 ± 2.78 weeks, respectively, P < 0.001), a higher incidence of full-term labor (60.26% vs 42.50%, P = 0.05) with no significant difference of perinatal mortality (P = 0.661). Meanwhile, higher incidence of normal birth weight infants (88.46% vs 67.50%, P = 0.007) was shown in laparoscopic group with no more complications such as the cases of neonatal with Apgar < 7 (P = 0.296), and the incidence of NICU admission (P = 0.237). Besides, LTC showed good efficiency on VTC in the incidence of full-term labor: HR 0.24 (95% CI 0.070-0.85), P < 0.001. While LSC showed the similar efficiency on VSC: HR 0.734 (95% CI 0.36-1.49), P = 0.857, showing that cases with twin pregnancy may benefit more from laparoscopic cerclage. CONCLUSIONS The comparative effect between laparoscopic and transvaginal cerclage in pregnant women showed that laparoscopic cerclage may be a relatively effective and safety prophylactic way for cervical insufficiency. This would be an acceptable and safe replace for traditional transvaginal cervical cerclage.
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Affiliation(s)
- Tiefeng Cao
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Sun Yat-sen University, 58 zhongshan 2nd road, Yuexiu District, Guangzhou, 510070, Guangdong, People's Republic of China
| | - Jinhui Li
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Sun Yat-sen University, 58 zhongshan 2nd road, Yuexiu District, Guangzhou, 510070, Guangdong, People's Republic of China
| | - Huimin Shen
- Department of Gynecology and Obstetrics, First Affiliated Hospital of Sun Yat-sen University, 58 zhongshan 2nd road, Yuexiu District, Guangzhou, 510070, Guangdong, People's Republic of China.
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Two Successful Livebirths from Both Hemiuteruses After Laparoscopic Cervical Cerclage in a Uterus Didelphys Patient with Cervical Insufficiency. MATERNAL-FETAL MEDICINE 2022. [DOI: 10.1097/fm9.0000000000000143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Na XN, Cai BS. Removal of laparoscopic cerclage stitches via laparotomy and rivanol-induced labour: A case report and literature review. World J Clin Cases 2022; 10:304-308. [PMID: 35071532 PMCID: PMC8727257 DOI: 10.12998/wjcc.v10.i1.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/27/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Laparoscopic cervical cerclage is performed for patients with abnormal cervical anatomy and/or transvaginal cervical cerclage failure. However, the method of removing the stitches to allow labour induction remains controversial. According to published literature, stitches are removed through laparoscopic or transvaginal methods. Herein, we report, for the first time, a case of a patient who had undergone laparoscopic cerclage, and then underwent removal of stitches by laparotomy and labour induction in the third trimester of pregnancy.
CASE SUMMARY A patient who underwent laparoscopic cervical cerclage due to cervical insufficiency became pregnant naturally following the operation. At 31 wk of pregnancy, severe foetal malformations were found. To successfully induce labour, cerclage stitches were removed via laparotomy, and rivanol was injected directly into the uterus. Following successful induction of labour, the patient delivered a dead foetus.
CONCLUSION This report provides a reliable scheme of removing cerclage stitches for patients who have undergone laparoscopic cerclage but experience severe foetal malformations.
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Affiliation(s)
- Xin-Ni Na
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ben-Shuo Cai
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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