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Abdominal cerclage in twin pregnancy after radical surgical conization.

Kyvernitakis I, Lotgering F, Arabin B - Case Rep Obstet Gynecol (2014)

Bottom Line: Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth.A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency.Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Prenatal and Perinatal Medicine, Clara Angela Foundation, Koenigsallee 36, 14193 Berlin, Germany ; Department of Pre- and Perinatal Medicine, Center of Mother and Child, University Hospital of Giessen and Marburg, Philipps University of Marburg, Campus Marburg, Baldinger Straße 1, 35043 Marburg, Germany.

ABSTRACT
Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

No MeSH data available.


Related in: MedlinePlus

Dorsal (a) and ventral (b) view of the Mersilene band, located at the cervicoisthmic junction. The band is tied on the anterior side of the cervix and the cut ends are fixed to the band with thin nonabsorbable sutures (b).
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fig2: Dorsal (a) and ventral (b) view of the Mersilene band, located at the cervicoisthmic junction. The band is tied on the anterior side of the cervix and the cut ends are fixed to the band with thin nonabsorbable sutures (b).

Mentions: The patient was counseled for high risk of preterm delivery associated with short cervix and twin gestation, using the publication of Lotgering [4] as a handout. The advantages and disadvantages of expectant management, Arabin pessary, transvaginal cerclage, and transabdominal cerclage were discussed. In an effort to optimize chances to reach viable gestational age we elected to perform transabdominal cerclage. The operation took place at 12 4/7 weeks under general anesthesia at the Radboud University Nijmegen Medical School, Nijmegen, as previously described [2, 3]. In short, after exposing the uterus, the cervicoisthmic junction was visualized and the cerclage (5 mm wide Mersilene ribbon, Ethicon, Norderstedt, Germany) was inserted through the avascular triangle between the ascending and descending branches of the uterine artery on each side (Figures 2(a) and 2(b)). The patient was discharged three days after surgery. TVS showed a cervical length (CL) of 25 mm below the cerclage.


Abdominal cerclage in twin pregnancy after radical surgical conization.

Kyvernitakis I, Lotgering F, Arabin B - Case Rep Obstet Gynecol (2014)

Dorsal (a) and ventral (b) view of the Mersilene band, located at the cervicoisthmic junction. The band is tied on the anterior side of the cervix and the cut ends are fixed to the band with thin nonabsorbable sutures (b).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3926403&req=5

fig2: Dorsal (a) and ventral (b) view of the Mersilene band, located at the cervicoisthmic junction. The band is tied on the anterior side of the cervix and the cut ends are fixed to the band with thin nonabsorbable sutures (b).
Mentions: The patient was counseled for high risk of preterm delivery associated with short cervix and twin gestation, using the publication of Lotgering [4] as a handout. The advantages and disadvantages of expectant management, Arabin pessary, transvaginal cerclage, and transabdominal cerclage were discussed. In an effort to optimize chances to reach viable gestational age we elected to perform transabdominal cerclage. The operation took place at 12 4/7 weeks under general anesthesia at the Radboud University Nijmegen Medical School, Nijmegen, as previously described [2, 3]. In short, after exposing the uterus, the cervicoisthmic junction was visualized and the cerclage (5 mm wide Mersilene ribbon, Ethicon, Norderstedt, Germany) was inserted through the avascular triangle between the ascending and descending branches of the uterine artery on each side (Figures 2(a) and 2(b)). The patient was discharged three days after surgery. TVS showed a cervical length (CL) of 25 mm below the cerclage.

Bottom Line: Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth.A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency.Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

View Article: PubMed Central - PubMed

Affiliation: Department of Prenatal and Perinatal Medicine, Clara Angela Foundation, Koenigsallee 36, 14193 Berlin, Germany ; Department of Pre- and Perinatal Medicine, Center of Mother and Child, University Hospital of Giessen and Marburg, Philipps University of Marburg, Campus Marburg, Baldinger Straße 1, 35043 Marburg, Germany.

ABSTRACT
Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy.

No MeSH data available.


Related in: MedlinePlus