The Incompetent Cervix in Repetitive Abortion and Premature Labor

Easterday, Charles L.; Reid, Duncan E.

doi:10.1056/nejm195904022601403

Cited by 42 publications

(20 citation statements)

References 5 publications

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“…This condition, defined as cervical incompetence (CI), is often characterized by a positive anamnesis for recurrent abortion in the second trimester or PTD at the beginning of the third trimester, subsequent to asymptomatic dilation of the cervix with prolapse of lower pole of the gestational sac into the vagina, even in the absence of an appreciable myometrial contractile activity [1]. In these cases, the prognosis for the fetus is in most cases unfavorable, and therefore is strongly indicated every possible attempt to prolong the pregnancy as much as possible [2]. In 1948, Palmer and La Comme [3] provided an extensive description of this condition, and in the following years several surgical techniques were developed for its treatment either with vaginal approach [4, 5], and, in special in particular cases, also with transabdominal one [6].…”

Section: Introductionmentioning

confidence: 99%

“…While there are no statistically significant differences between vaginal cerclage performed with the Shirodkar or McDonald technique, it has been suggested that the four steps technique can be considered the most valid method. In fact, it is believed that the few but deep passages of the tape in the thickness of the cervical tissue can result in better grip and seal, and, therefore, have a lower tendency to dislocation, a greater resistance to dilation and a reduced risk of lacerations of the cervix in the case of myometrial contractile activity [2, 15]. In the current study, we used a combination of the Shirodkar and McDonald’s ones that in our opinion is faster and simpler to perform and holds better respect to other surgical procedures of cervical cerclage.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

et al. 2015

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BackgroundSeveral techniques of emergency vaginal cerclage have been proposed in case of unexpected and abrupt cervical incompetence (CI), in order to prolong the pregnancy as much as possible and to reduce the adverse maternal-fetal outcomes. The aim of our study was to evaluate the effectiveness of emergency cervical cerclage, performed with the combined modified Shirodkar-McDonald technique.MethodsWe selected 12 cases of emergency vaginal cerclage, performed between January 1, 2008 and June 30, 2013. The age of the patients was between 20 and 38 years (mean 29.0 ± standard deviation (SD) 5.69), parity between 0 and 2 (mean 0.7 ± SD 0.65), and gestational age at the time of admission ranged between 17 and 26 weeks (mean 21.0 ± SD 3.44). In all these cases, we used a combined modified Shirodkar-McDonald technique to perform the procedure.ResultsThe neonatal survival rate was 83.3%. The cesarean section rate was 16.7%. The average pregnancy prolongation was 89.9 days, higher than that reported for other studies in the literature.ConclusionsWe can assume that the emergency vaginal cerclage performed with the combined modified Shirodkar-McDonald technique is the best option of surgical therapy for the treatment of unexpected and abrupt CI.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

et al. 2015

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“…Classic cervical insufficiency is a diagnosis, based on an obstetric history of recurrent second- or early third-trimester fetal loss, following painless cervical dilatation, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity [1]. In the absence of the classic recurrence, the term cervical insufficiency is generally used as a work-diagnosis based on a single event with the same characteristic clinical history after exclusion of other possible causes of preterm delivery.…”

Section: Introductionmentioning

confidence: 99%

Clinical aspects of cervical insufficiency

Lotgering

2007

BMC Pregnancy Childbirth

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Fetal loss is a painful experience. A history of second or early third trimester fetal loss, after painless dilatation of the cervix, prolapse or rupture of the membranes, and expulsion of a live fetus despite minimal uterine activity, is characteristic for cervical insufficiency. In such cases the risk of recurrence is high, and a policy of prophylactic cerclage may be safer than one of serial cervical length measurements followed by cerclage, tocolysis and bed rest in case of cervical shortening or dilatation. In low risk cases, however, prophylactic cerclage is not useful. There is a need for more basic knowledge of cervical ripening, objective assessment of cervical visco-elastic properties, and randomized controlled trials of technical aspects of cervical cerclage (e.g. suturing technique).

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“…1 The diagnosis is usually made in retrospect, based on the clinical history and after exclusion of possible causes of preterm uterine activity. Previous reports suggest that about 1% of all pregnant women and 8% of women who suffered second or early third-trimester losses could be affected.…”

Section: 5005/jp-journals-10016-1052mentioning

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 Incompetent Cervix in Repetitive Abortion and Premature Labor

Cited by 42 publications

References 5 publications

Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

Evaluation of Maternal-Fetal Outcomes After Emergency Vaginal Cerclage Performed With Shirodkar-McDonald Combined Modified Technique

Clinical aspects of cervical insufficiency

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?

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