Lantern on Dome of St. Paul’s – A Huge Cervical Fibroid

Thakur, Monika; Rathore, eep; Jindal, Aditi; Thakur, Angesh; Mahajan, Kunal; Gupta, Gunjan

doi:10.21767/2471-8041.100095

Cited by 8 publications

(16 citation statements)

References 2 publications

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“…Primigravida patients commonly present in mid-trimester with minimal mild complaints like feeling of heaviness or discomfort in lower abdomen or with an ultrasound report suggestive of short cervix. 3,8,9 Similar presentations were seen among our patients as well.…”

Section: Discussionsupporting

confidence: 87%

“…3,9 Cervical cerclage of various types at various stages of gestation has shown to improve viability of fetus and is the preferred surgical management for cervical insufficiency. 3,8,10,11 We herein present two case reports of congenital cervical insufficiency managed with elective and emergency cervical cerclage culminating in successful pregnancy outcomes.…”

Section: Introductionmentioning

confidence: 98%

“…6,7 CI may be because of congenital or acquired causes. 3,8,9 The diagnosis is usually done retrospectively through careful history taking with special emphasis on previous family history and review of medical records along with transvaginal ultrasound for measurement of cervical length. 3,9 Cervical cerclage of various types at various stages of gestation has shown to improve viability of fetus and is the preferred surgical management for cervical insufficiency.…”

Section: Introductionmentioning

confidence: 99%

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Outcome of different cerclage methods in two cases of congenital cervical insufficiency: a case report

et al. 2021

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Cervical insufficiency (CI) or progressive shortening and thinning of cervix is a contributor to perinatal mortality through spontaneous mid-trimester miscarriages or early preterm birth. Congenital factors for cervical insufficiency are rarer than acquired factors. The lack of definitive criteria or methods is a challenge for diagnosis of such cases. Different cerclage methods and timely cerclage have shown to improve the outcome of pregnancy in patients with congenital cervical insufficiency (CCI). Here, we report two cases of CCI managed with different methods of cerclage culminating in successful pregnancy outcomes.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Outcome of different cerclage methods in two cases of congenital cervical insufficiency: a case report

et al. 2021

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“…1 This clinical entity has an approximate incidence of 0.5% in the general obstetric population and 8% in women with a history of previous mid-trimester miscarriage. 2 Cervical insufficiency can be either acquired or congenital with the most prevalent risk factors being cervical lacerations during childbirth, trachelectomy, cone biopsy, loop electrosurgical excision procedure, forced cervical dilatation during previous uterine evacuation, impaired embryological development of Müllerian ducts, and maternal connective tissue diseases associated with collagen deficiency (ie, Marfan and Ehlers-Danlos syndromes). [2][3][4] However, in many cases, cervical incompetence has no profound etiology and is characterized as idiopathic.…”

mentioning

confidence: 99%

“…2 Cervical insufficiency can be either acquired or congenital with the most prevalent risk factors being cervical lacerations during childbirth, trachelectomy, cone biopsy, loop electrosurgical excision procedure, forced cervical dilatation during previous uterine evacuation, impaired embryological development of Müllerian ducts, and maternal connective tissue diseases associated with collagen deficiency (ie, Marfan and Ehlers-Danlos syndromes). [2][3][4] However, in many cases, cervical incompetence has no profound etiology and is characterized as idiopathic. 3 The prevention of PTD remains a major challenge in current obstetrics, despite decades of research and advances in diagnostic techniques, with cervical insufficiency being one of the most controversial underlying causes, with a complex pathophysiology.…”

mentioning

confidence: 99%

Cervical Cerclage: A Comprehensive Review of Major Guidelines

Giouleka,

Boureka,

Tsakiridis

et al. 2023

Obstetrical &Amp; Gynecological Survey

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Importance Cervical cerclage (CC) represents one of the few effective measures currently available for the prevention of preterm delivery caused by cervical insufficiency, thus contributing in the reduction of neonatal morbidity and mortality rates. Objective The aim of this study was to review and compare the most recently published major guidelines on the indications, contraindications, techniques, and timing of placing and removal of CC. Evidence Acquisition A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal College of Obstetricians and Gynaecologists (RCOG), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the International Federation of Gynecology and Obstetrics (FIGO) on CC was carried out. Results There is a consensus among the reviewed guidelines regarding the recommended techniques, the indications for rescue CC, the contraindications, as well as the optimal timing of CC placement and removal. All medical societies also agree that ultrasound-indicated CC is justified in women with history of prior spontaneous PTD or mid-trimester miscarriage and a short cervical length detected on ultrasound. In addition, after CC, serial sonographic measurement of the cervical length, bed rest, and routine use of antibiotics, tocolysis, and progesterone are unanimously discouraged. In case of established preterm labor, CC should be removed, according to ACOG, RCOG, and SOGC. Furthermore, RCOG and SOGC agree on the prerequisites that should be met before attempting CC. These 2 guidelines along with FIGO recommend history-indicated CC for women with 3 or more previous preterm deliveries and/or second trimester pregnancy miscarriages, whereas the ACOG suggests the use of CC in singleton pregnancies with 1 or more previous second trimester miscarriages related to painless cervical dilation or prior CC due to painless cervical dilation in the second trimester. The role of amniocentesis in ruling out intra-amniotic infection before rescue CC remains a matter of debate. Conclusions Cervical cerclage is an obstetric intervention used to prevent miscarriage and preterm delivery in women considered as high-risk for these common pregnancy complications. The development of universal international practice protocols for the placement of CC seems of paramount importance and will hopefully improve the outcomes of such pregnancies. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be able to identify the indications and contraindications of cervical cerclage; evaluate the prerequisites before cervical cerclage placement; and explain the strategies for perioperative and postoperative care after cervical cerclage placement.

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Сervical insufficiency after timely childbirth - what went wrong?

Bila,

Chernega

2023

UJHW

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Premature birth is a serious global medical problem. About 15 million premature babies are born annually in the world, of which 1 million dies. Spontaneous premature birth is a cause of 40-45% of all premature births. Cervical insufficiency (CI) is a significant risk factor for spontaneous premature birth. Purpose - to identify the risk factors for the development of CI in patients with a history of full-term pregnancies to draw attention to the problem of underdiagnosis of hidden obstetric injuries. Materials and methods. During 2021 – June 2023, a retrospective cohort study was conducted in the municipal non-profit enterprise “Kyiv Perinatal Center”, within which 140 patients were analyzed. The study group includes 70 patients who have a history of at least one full-term pregnancy, and who had a diagnosis of CI during the last pregnancy. The control group consisted of patients who had 2 or more pregnancies, during which they were not diagnosed with CI. Results. The odds of developing CI during the next pregnancy increased compared with the control group in the presence of the following: rapid delivery - up to ≈4:1; prolonged second stage of labour - up to ≈6.5:1; cervical surgery with cervical dilatation - up to ≈4.7:1; cervical surgery without cervical dilatation - up to ≈4.1:1. Previous spontaneous preterm delivery was not found to be a predictor of CI development at subsequent pregnancies. Conclusions. The results show that patients with precipitous delivery and surgical manipulations on the cervix in history have at least 4 times higher the risk of CI development after timely childbirth, and with a prolonged second period of childbirth - have 6.5 times higher risk. It should be noted that statistically significant differences were not found in patients who had spontaneous preterm delivery. We also postulate that such data indicate two possible phenotypes of the CI: one is of traumatic genesis, and the second is of congenital tendency of the cervix to weakness, which can first manifest in the form of precipitous childbirth, and subsequently manifest in the form of CI. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the women was obtained for the research. No conflict of interests was declared by the authors.

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Lantern on Dome of St. Paul’s – A Huge Cervical Fibroid

Cited by 8 publications

References 2 publications

Outcome of different cerclage methods in two cases of congenital cervical insufficiency: a case report

Outcome of different cerclage methods in two cases of congenital cervical insufficiency: a case report

Cervical Cerclage: A Comprehensive Review of Major Guidelines

Сervical insufficiency after timely childbirth - what went wrong?

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