Laparoscopic Transabdominal Cerclage for Cervical Incompetence: A Feasible and Effective Treatment in 10 Steps

Smith, Andres Vigueras; Cabrera, Ramiro; Zomer, Monica Tessmann; Ribeiro, Reitan; Talledo, Renzo; Kondo, William

doi:10.1016/j.jmig.2019.10.019

Cited by 5 publications

(3 citation statements)

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“…Successful cervical cerclage will improve the outcome of pregnancy, prolong the pregnancy as much as possible, and reduce the cost of treatment and rehabilitation of premature infants [ 12 ]. It is safe and feasible to perform laparoscopic cervical cerclage with medical history indication in non-pregnant women with cervical incompetence, plus the inherent advantages of minimally invasive surgery, and it has better obstetric outcomes [ 13 ]. In this paper, we retrospectively studied the influence of laparoscopic and transvaginal surgical routes on pregnancy outcome in view of the indication of cervical cerclage with medical history.…”

Section: Discussionmentioning

confidence: 99%

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Qin

Yang

Zhou

et al. 2023

Arch Gynecol Obstet

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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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Section: Discussionmentioning

confidence: 99%

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Qin

Yang

Zhou

et al. 2023

Arch Gynecol Obstet

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“…Laparoscopic cerclage stitches can be removed by laparotomic, laparoscopic, and transvaginal approaches. For pregnant women with normal foetuses at full term or near term, caesarean section is commonly performed for delivery, and cerclage stitches were removed during the procedure[ 14 ]. For pregnancies that should be terminated because of foetal abnormalities or third-trimester foetal death, the methods of removing cerclage stitches and inducing labour remain controversial.…”

Section: Discussionmentioning

confidence: 99%

Removal of laparoscopic cerclage stitches via laparotomy and rivanol-induced labour: A case report and literature review

Na¹,

Cai²

2022

WJCC

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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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“…Enlarged uterus due to pregnancy inevitably result in ureter compression because of the adjacent location between lower segment ureter and cervix [28][29][30]. The operation of ureteroscope would inevitably stimulate the cervix, long time and repeatedly physical stimulation could trigger uterine contraction.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of uterine contraction after ureteroscopy in pregnant women with renal colic

Guo

Luo

et al. 2021

Int Urol Nephrol

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Background Ureteroscopy is widely applied in pregnant women with renal colic, but such patients are easy to experience uterine contraction after surgery. There are many factors which may affect uterine contraction, this study aims to explore the risk factors of uterine contraction triggered by ureteroscopy in pregnant women with renal colic. Methods One hundred and one pregnant women were retrospectively analyzed, the patients were hospitalized because of severe renal colic. All patients received ureteroscopy during which double J catheters were inserted into ureters for drainage. Patients received other medical treatments individually according to their condition and uterine contractions were detected by EHG within 12 h after operation. Patients were classified as group A (uterine contraction) and group B (no uterine contraction) according to the presence or absence of continuously regular uterine contraction. Clinical characteristics were collected for further analysis, including history of childbirth, anesthesia method, application of phloroglucinol or not, operation time, Oxygen inhalation or not, pain relief or not after surgery, systemic inflammatory response syndrome (SIRS) occurred or not. A binary logistic regression analysis model was established to explore whether such clinical characteristics were relevant to uterine contraction after ureteroscopy. Results Continuously regular uterine contraction presented in 46 pregnant women within 12 h after ureteroscopy, making the incidence of uterine contraction as high as 45.54%. The presence of uterine contraction was related to the following factors(P < 0.05): history of childbirth (primipara versus multipara)(OR 6.593, 95% CI 2.231–19.490), operation time (each quarter additional) (OR 2.385, 95% CI 1.342–4.238), application of phloroglucinol (yes versus not) (OR 6.959, 95% CI 1.416–34.194), pain relief after surgery(yes versus not)(OR 6.707, 95% CI 1.978–22.738), SIRS occurred after surgery (yes versus not) (OR 0.099, 95% CI 0.014–0.713). Conclusion Continuously regular uterine contraction is easy to occur within 12 h after ureteroscopy in pregnant women. SIRS occurred after surgery is a risk factor for uterine contraction; on the contrary, no history of childbirth, shorter operation time, application of phloroglucinol, pain relief after surgery are protective factors.

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Laparoscopic Transabdominal Cerclage for Cervical Incompetence: A Feasible and Effective Treatment in 10 Steps

Cited by 5 publications

References 0 publications

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage

Removal of laparoscopic cerclage stitches via laparotomy and rivanol-induced labour: A case report and literature review

Risk factors of uterine contraction after ureteroscopy in pregnant women with renal colic

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