T O Adedipe1, A A Akintunde2, U O Chukwujama3. 1. Women and Children's Hospital, Hull University Teaching Hospital NHS Trust, Hull, HU3 2JZ, UK. Busolade@gmail.com. 2. Good Hope Hospital, Rectory road, Birmingham, B75 7RR, UK. 3. Women and Children's Hospital, Hull University Teaching Hospital NHS Trust, Hull, HU3 2JZ, UK.
Abstract
BACKGROUND: Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is significant difficulty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with increased neonatal morbidity and mortality. METHODS: A retrospective review of 5 consecutive cases managed by a surgical technique-modified high vaginal cerclage insertion at 18-20 weeks-and adjunct protocols which included vaginal progesterone use, serial infection screening and lifestyle advice, over a 12-month period ending in August 2021, is presented. Inclusion criteria included minimal or absent ecto-cervix, singleton pregnancies with an incompetent cervix attending for a vaginal cerclage whilst exclusion criteria were the usual contraindications to a cerclage insertion. Primary outcome was delivery after 34 weeks whilst seconday outcomes included maternal hemorrhage, bowel/bladder injury, chorioamnionitis and neonatal admission. RESULTS: A increased gestational latency of 13 gestational weeks (range 12-18). Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241-264 days. Delivery after 34 weeks gestational age was 100% with no maternal surgical complications and corresponding neonatal outcomes. CONCLUSION: There is a potential therapeutic benefit of this technique and adjunct management, in managing an incompetent mid-2nd trimester absent ecto-cervix.
BACKGROUND: Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is significant difficulty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with increased neonatal morbidity and mortality. METHODS: A retrospective review of 5 consecutive cases managed by a surgical technique-modified high vaginal cerclage insertion at 18-20 weeks-and adjunct protocols which included vaginal progesterone use, serial infection screening and lifestyle advice, over a 12-month period ending in August 2021, is presented. Inclusion criteria included minimal or absent ecto-cervix, singleton pregnancies with an incompetent cervix attending for a vaginal cerclage whilst exclusion criteria were the usual contraindications to a cerclage insertion. Primary outcome was delivery after 34 weeks whilst seconday outcomes included maternal hemorrhage, bowel/bladder injury, chorioamnionitis and neonatal admission. RESULTS: A increased gestational latency of 13 gestational weeks (range 12-18). Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241-264 days. Delivery after 34 weeks gestational age was 100% with no maternal surgical complications and corresponding neonatal outcomes. CONCLUSION: There is a potential therapeutic benefit of this technique and adjunct management, in managing an incompetent mid-2nd trimester absent ecto-cervix.
Authors: Natasha L Hezelgrave; Helena A Watson; Alexandra Ridout; Falak Diab; Paul T Seed; Evonne Chin-Smith; Rachel M Tribe; Andrew H Shennan Journal: BMC Pregnancy Childbirth Date: 2016-11-21 Impact factor: 3.007
Authors: Agatha S Critchfield; Grace Yao; Aditya Jaishankar; Ronn S Friedlander; Oliver Lieleg; Patrick S Doyle; Gareth McKinley; Michael House; Katharina Ribbeck Journal: PLoS One Date: 2013-08-01 Impact factor: 3.240