SMFM paper
Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage

Presented at the 27th Annual Clinical Meeting of the Society for Maternal-Fetal Medicine, San Francisco, CA, Feb. 5-10, 2007.
https://doi.org/10.1016/j.ajog.2007.06.060Get rights and content

Objective

The purpose of this study was to assess the outcome after transabdominal-cerclage placement during pregnancy in women with previous unsuccessful transvaginal cerclage.

Study Design

We conducted a retrospective case series that described pregnancy outcome in women who were treated with transabdominal cerclage between 1994 and 2006.

Results

Seventy-five women with negative evaluation for recurrent pregnancy loss and ≥1 previous unsuccessful transvaginal cerclage procedures were treated with transabdominal cerclage. The median gestational age at the time of cerclage placement was 13 weeks, and the median gestational age at delivery was 36 weeks. Seventy-two women delivered after 24 weeks of gestation, and 3 women delivered ≤24 weeks of gestation. The fetal-salvage after transabdominal cerclage was 96%.

Conclusion

Our findings suggest that, in women with a history of ≥1 failed transvaginal cerclage, transabdominal cerclage is an effective procedure.

Section snippets

Materials and Methods

One hundred fourteen patients were referred to a single Maternal Fetal Medicine specialist (R.H.D.) between 1994 and 2006. Strict criteria were used to identify appropriate candidates for TAC placement. Preconception work up included a hysterosalpingogram or sonohysterogram for uterine cavity evaluation (75 patients). Thrombophilia work-up was performed that included anticardiolipin antibody (ACA) immunoglobulin G/M, lupus anticoagulant (LAC), protein S and C levels, antigen (Ag), antithrombin

Results

The results after TAC are shown in Table 1. Seventy-five women underwent 75 TAC procedures in singleton pregnancies. Seventy-two patients had no intraoperative or postoperative complications of TAC placement. The most serious complication of TAC placement was a bowel perforation that occurred while the right angle clamp passed through the broad ligament. This was oversewn with no subsequent sequelae. One woman had an incisional hernia, and another woman had a wound infection. No patients

Comment

Cervical insufficiency often is diagnosed on the basis of an obstetric history of repeated painless mid-trimester losses or preterm deliveries. Although TVC has been an accepted management for cervical insufficiency for decades, its efficacy remains in question. TAC has been used in women with congenitally short or extensively amputated cervices, markedly scarred or lacerated cervices, cervicovaginal fistulas, subacute cervicitis, or failed TVC. In this retrospective series, we present a large

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Cite this article as: Debbs RH, DeLa Vega GA, Pearson S, Sehdev H, Marchiano D, Ludmir J. Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage. Am J Obstet Gynecol 2007;197:317.e1-317.e4.

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