Cervicoisthmic cerclage: transabdominal vs transvaginal approach

Witt, Marili U.; Joy, Saju; Clark, J. Madison; Herring, Amy H.; Bowes, Watson A.; Thorp, John M.

doi:10.1016/j.ajog.2009.03.020

Cited by 45 publications

(33 citation statements)

References 17 publications

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“…Reported complications include signifi cant blood loss, chorioamnionitis, and premature rupture of membranes (PROM). In addition, some studies report similar eff ectiveness between the TVC and TAC procedures in prolonging the pregnancy (Golfi er et al 2001;Hole et al 2003;Rand and Norwitz 2003;Witt, et al 2009), while others have shown that TAC is associated with fewer recurrent pre-term births and improved neonatal survival compared with previous pregnancies or failed TVC used as controls (Novy 1991;Craig and Fliegner 1997;Turnquest et al 1999;Lotgering et al 2006). Compared with placement of TVC repeatedly in the face of prior failure, TAC produces fewer recurrent pre-term births and improved neonatal survival (Zaveri et al 2002;Debbs and Chen 2009).…”

mentioning

confidence: 96%

“…Customarily, most patients undergoing a TAC will have it done by laparotomy, which means the patient must have two laparotomies during pregnancy. Transabdominal cerclage has been associated with serious operative complications compared with a TVC (Zaveri et al 2002;Witt et al 2009). Although Mahran (2000) reported a signifi cant incidence of later pregnancy complications, these complications may well refl ect the healthcare available to them or accessed by them, rather than the surgeon ' s experience or the surgery itself.…”

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confidence: 99%

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Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

Foster

Moore

Sumners

2011

Journal of Obstetrics and Gynaecology

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This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks' gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.

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confidence: 96%

mentioning

confidence: 99%

Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

Foster

Moore

Sumners

2011

Journal of Obstetrics and Gynaecology

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“…With recent evidence supporting the efficacy of the use of 17 α-hydroxy progesterone caproate to prevent recurrent preterm births, patients with a history of spontaneous preterm birth including those whose history is consistent with cervical insufficiency have been offered both transvaginal cerclage and progesterone in hope of achieving an improved pregnancy outcome. 10 In our study, we have not routinely administered progesterones and, hence, did not analyze any effects of progesterone. A prospective study that compares relative benefits of the administration of progesterone in this group is necessary.…”

Section: Discussionmentioning

confidence: 99%

Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices?

Gundabattula¹,

Marakani²,

Dasari³

2013

International Journal of Infertility &Amp; Fetal Medicine

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Objective To assess the reduction in fetal loss following transabdominal cervicoisthmic cerclage done for repeated failed vaginal cerclages and/or inaccessible cervices. Study design An observational study of 113 pregnancies in 90 women after transabdominal cervicoisthmic cerclage from January 1999 to December 2010 at Fernandez Hospital, Hyderabad, Andhra Pradesh, India. Results Mean gestational age at the time of elective transabdominal cervicoisthmic cerclage was 11.6 weeks. Patients were delivered by lower segment cesarean section (LSCS) with a mean gestational age of 36 weeks. Live birth rate was 90.5%. Incidence of mid-trimester miscarriages was 8.6% after cerclage compared with 62.9% before cerclage. Before cerclage, only 13.1% pregnancies continued beyond 28 weeks whereas after cerclage, 88.6% crossed the period of viability. Prior to cerclage, preterm delivery rate was 7.0% (as majority of the pregnancies were lost prior to period of clinical viability) and only 13.6% of these preterm babies survived. Although the incidence of preterm deliveries was 23.8% after cerclage, 80% of these preterm babies survived. Excluding first-trimester miscarriages, fetal loss was 93.3% prior to cerclage and 13.7% postcerclage. In effect, the take home baby rate among pregnancies was only 5.8% before cerclage compared with 86.7% after cerclage. Mean birth weight after cerclage was 2.5 kg. Conclusion Transabdominal cerclage reduces fetal loss and improves pregnancy outcome in women who had failed vaginal cerclages and in those with inaccessible cervices. How to cite this article Marakani LR, Dasari S, Gundabattula SR, Joseph E. Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices? Int J Infertility Fetal Med 2013;4(1):1-5.

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“…The end of the second trimester heralds the end of the natural foetal wastage; hence, choosing 13 weeks as the earliest time for the insertion of transvaginal cerclage is logical while the selection of 26 weeks as the latest cutoff time is probably influenced by advances in neonatal medicine and better neonatal survival rates achieved by many units in infants delivered at or beyond 26 weeks gestation. Although transabdominal cervical cerclage carries potentially higher morbidity [30], it may offer improved neonatal survival with lesser morbidity in carefully selected women [31][32][33][34][35] and performing the procedure preconceptionally might be a safer alternative [36]. Almost half of the respondents (48%) agree with this assumption and would offer it to women who had excisional treatment, repeated treatments, second trimester loss, preterm labour or PROM, and this could be an overrepresentation of those who would actively intervene.…”

Section: Discussionmentioning

confidence: 99%

Survey: the management of pregnant women with a history of excisional treatment of the uterine cervix for cervical intra-epithelial neoplasia

Basama

Angala

2010

Gynecol Surg

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The purpose of this study is to gauge the management of pregnant women with a past history of cervical excisional treatments for cervical intra-epithelial neoplasia (CIN). A postal survey of 120 consultant obstetricians and gynaecologists in the northwest of England was done. The response rate was 41.7%. Thirty-seven respondents (74%) agreed with the evidence that cervical excisional treatment increases the risk of late miscarriage, preterm labour, premature rupture of the membranes and spontaneous rupture of the membranes at term. Thirty-one (62%) think that cervical assessment during pregnancy in women who had excisional treatments is not essential, nevertheless, 72% of the respondents utilise transvaginal ultrasonography alone or in combination with other methods to assess the cervix in these women. Seventeen (34%) assess the cervix monthly and nineteen (38%) carry out variable assessments ranging between once in the first trimester and every 6-8 weeks. Thirty-one (62%) offer cervical cerclage and 28 (56%) will offer it between 13-16 weeks gestation. Twenty-four (48%) would offer preconception transabdominal cervical cerclage to at-risk women. Forty (80%) do not believe that previous excisional treatment will alter the vaginal flora and only eight (16%) perform high vaginal swabs. There is a lack of consensus and consistency in the cervical assessment for the prediction of the risk of preterm birth in women who had cervical excisional treatments for CIN. Transvaginal ultrasonography alone or in combination with other methods is the most favoured technique in cervical assessment. The majority of the respondents offer cervical cerclage. In the presence of evidence that cervical excisional treatment for CIN carries a real risk of pregnancy loss and morbidity, there is a need for an agreed and standardised strategy in cervical assessment and intervention techniques.

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Cervicoisthmic cerclage: transabdominal vs transvaginal approach

Cited by 45 publications

References 17 publications

Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

Can We reduce Fetal Loss with Second Trimester Miscarriages and very Preterm Births due to Cervical Incompetence in Women with Repeated Failed Vaginal Cerclages and/or Inaccessible Cervices?

Survey: the management of pregnant women with a history of excisional treatment of the uterine cervix for cervical intra-epithelial neoplasia

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