Successful cerclage on cervix in the mid trimester: case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20193950Keywords:
Cervical cerclage, Cervical incompetence, McDonald cerclage, Preterm delivery, Shirodkar cerclageAbstract
Cervical cerclage (CC) has been utilized for the cure of loss in second trimester pregnancy. The detection of cervical incompetency is problematic normally having repeated second trimester demise or early preterm delivery after cervical dilatation without pain having no bleeding, contractions, or other reasons for repeated loss in pregnancy. This study was performed at a tertiary care hospital in Dhaka, Bangladesh. These are 2 cases of patients undergoing emergency mid-trimester cerclage for advanced cervical dilatation with protruding membranes in 2016 and 2017. The 1st case patient was at 22 weeks of gestation and was admitted into hospital due to short history of lower abdominal pain and per vaginal bleeding. Vaginal inspection showed the cervix was dilated 1.5 cm. At 37 weeks of pregnancy she gave birth to a healthy female newborn by caesarean section and McDonald suture was removed. After delivery, mother and baby both were in good health. The 2nd case was of a patient of 26 years of age, second gravida, 24 weeks pregnant due to ovulation induction drug, who had a history of an abortion at 10 weeks. At her 24 weeks of pregnancy, she complained of profuse P/V whitish discharge and lower abdominal pain. It was found cervix was 2.5 cm dilated and bulging of membrane. Immediately McDonald suture was given. Patient was clinically improved, and USG showed OS is closed, length of the cervix is about 4.4 cm. At 32 weeks patient came with a complaint of rupture of membrane, then emergency caesarean section was done. A healthy premature female baby weighted 1.8 kg was delivered by vertex presentation. After operation, cerclage was removed. After delivery mother and baby both were in good health. Satisfactory neonatal result may be achieved in women having cervical deficiency in second-trimester pregnancy after emergency CC.
References
Iams JD, Goldenberg RL, Meis PJ, Mercer BM, Moawad A, Das A, et al. The length of the cervix and the risk of spontaneous premature delivery. N Engl J Med. 1996;334(9):567-72.
Berghella V, Daly SF, Tolosa JE, DiVito MM, Chalmers R, Garg N, et al. Prediction of preterm delivery with transvaginal ultrasonography of the cervix in patients with high-risk pregnancies: does cerclage prevent prematurity? Am J Obstet Gynecol. 1999;181(4):809-15.
Owen J, Yost N, Berghella V, Thom E, Swain M, Dildy GA, et al. Mid-trimester endovaginal sonography in women at high risk for spontaneous preterm birth. JAMA. 2001; 286(11):1340-8.
Berghella V, Odibo A, To M, Rust O, Althuisius S. Cerclage for Short Cervix on Ultrasonography. Meta-Analysis of Trials Using Individual Patient-Level Data. Obstetrics and Gynecol. 2005; 106(1):181-9.
Shirodkar V. A new method of operative treatment for habitual abortions in the second trimester of pregnancy. Antiseptic. 1955; 52: 299-300.
McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynaecol Br Emp. 1957; 64(3):346-50.
Shortle B, Jewelewicz R. Clinical aspects of cervical incompetence. Chicago: Yearbook Medical Publishers; 1989.
Berghella V, Ludmir J, Simonazzi G, Owen J. Transvaginal cervical cerclage: evidence for perioperative management strategies. Am J Obstetr and Gynecol. 2013 Sep 1;209(3):181-92.
Parilla BV, Haney EI, MacGregor SN. The prevalence and timing of cervical cerclage placement in multiple gestations. Int J Gynecol Obstetr. 2003;80(2):123-7.
Deb P, Aftab N, Rangwala T. Successful cerclage at advanced cervical dilatation in the second trimester. Int J Infertility Fetal Med. 2013;4(2):56-8.
Liddiard A, Bhattacharya S, Crichton L. Elective and emergency cervical cerclage and immediate pregnancy outcomes: a retrospective observational study. JRSM short reports. 2011 Nov;2(11):1-6.
Ventolini G, Genrich TJ, Roth J, Neiger R. Pregnancy outcome after placement of ‘rescue’ Shirodkar cerclage. J Perinatol. 2009;29:276-9.
Cockwell HA, Smith GN. Cervical Incompetence and the Role of Emergency Cerclage. JOGC. 2005 Feb 1;27(2):123-9.
Pereira L, Cotter A, Gomez R, Berghella V, Prasertcharoensuk W, Rasanen J, et al. Expectant management compared with physical examination-indicated cerclage (EM-PEC) in selected women with a dilated cervix at 140/7-256/7 weeks: results from the EM-PEC international cohort study. Am J Obstet Gynecol. 2007 Nov 1;197(5):483-e1.
Hordnes K, Askvik K, Dalaker K. Emergency McDonald cerclage with application of stay sutures. Eur J Obstetr and Gynecol Reproductive Biol. 1996;64:43-9.
Heath VCF, Souka AP, Erasmus I, Gibb DMF, Nicolaides KH. Cervical length at 23 weeks of gestation: the value of Shirodkar suture for the short cervix. Ultrasound Obstet Gynecol. 1998;12(5):318-22.
Balasubramaniam D, Chitra TV, Panicker S. Outcome of emergency cerclage for advanced cervical dilatation: a retrospective analysis. International Journal of Research in Medical Sciences. Int J Res Med Sci. 2015;3(1):229-34.
Prasad NN, Thampan SA, R. Nagarathnamma. Emergency cervical cerclage and pregnancy outcomes. Int J Reprod Contracept Obstet Gynecol. 2017;6(5):1993-8.
Zhu LQ, Chen H, Chen LB, Liu YL, Tan JP, Wang YH, et al. Effects of Emergency Cervical Cerclage on Pregnancy Outcome: A Retrospective Study of 158 Cases. Med Sci Monit. 2015; 21: 1395-401.
Levin I, Salzer L, Maslovitz S, Avni A, Lessing JB, Groutz A, et al. Outcomes of Mid-Trimester Emergency Cerclage in Twin Pregnancies. Fetal Diagn Ther. 2012;32:246-50.
Skentou C, Souka AP, To MS, Liao AW, Nicolaides KH. Prediction of preterm delivery in twins by cervical assessment at 23 weeks. Ultrasound in Obstetrics and Gynecology: The Official J Int Society of Ultrasound in Obstetr and Gynecol. 2001 Jan;17(1):7-10.
Zanardini C, Pagani G, Fichera A, Prefumo F, Frusca T. Cervical cerclage in twin pregnancies. Arch Gynecol Obstet. 2013;288(2):267-71.
Ojabo A, Adesiyun AG, Hembah-Hilekaan SK, Mohammed-Durosinlorun A, Sulayman-Umar H. Ojabo, A, et al. Pregnancy Outcomes Following Emergency Cervical Cerclage. Open Access Library J. 2014;1:e970.
Deb P, Aftab N, Muzaffar S. Prediction of outcomes for emergency cervical cerclage in the presence of protruding membranes. ISRN Obstetr gynecol. 2012 Jan 24;2012.
Soliman KB, Abbas MM, Aref NK, Zada ZM. Emergency cerclage. A successful challenge despite advanced second trimester cervical dilatation. Saudi Med J. 2006; 27 (4): 544-546.
Al-Takroni AM, Aslam A, Parvathi CK, Shamdeen M, Hanbali M, Ahmed MS, et al. Emergency Cervical Cerclage: A Review of 15 Cases. Ann Saudi Med. 199919(1):23-6.
Khan MJ, Ali G, Al Tajir G, Sulieman H. Evaluation of Outcomes Associated with Placement of Elective, Urgent, and Emergency Cerclage. The J Obstetr Gynecol of India. 2012;62(6):660-4.
Lidegaard Ø. Cervical incompetence and cerclage in Denmark 198O-1990 A register based epidemiological survey. Acta obstetricia et gynecologica Scandinavica. 1994 Jan 1;73(1):35-8.
Namouz S, Porat S, Okun N, Windrim R, Dan Farine D. Emergency Cerclage: Literature Review. Obstetr Gynecol Survey. 2013;68(5):379-88.
Rebarber A, Bender S, Silverstein M, Saltzman DH, Klauser CK, Fox NS. Outcomes of emergency or physical examination-indicated cerclage in twin pregnancies compared to singleton pregnancies. Eur J Obstetr and Gynecol Reproductive Biol. 2014; 173:43-7.
Balasubramaniam D, Chitra TV, Panicker S. Outcome of emergency cerclage for advanced cervical dilatation: a retrospective analysis. Int J Research in Medical Sciences. Int J Res Med Sci. 2015;3(1):229-34.
Al-Takroni AMB, Aslam A, Parvathi CK, Shamdeen M, Hanbali M, Ahmed MS, et al. Emergency Cervical Cerclage: A Review of 15 Cases. Annals of Saudi Medicine. 1999;19(1):23-6.
Prasad NN, Thampan SA, Nagarathnamma R. Emergency cervical cerclage and pregnancy outcomes. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. Int J Reprod Contracept Obstet Gynecol 2017; 6(5):1993-8.
Zhu LQ, Chen H, Chen LB, Liu YL, Tan JP, Wang YH, et al. Effects of Emergency Cervical Cerclage on Pregnancy Outcome: A Retrospective Study of 158 Cases. Med Sci Monit. 2015;21:1395-401.
Heath VCF, Souka AP, Erasmus I, Gibb DMF, Nicolaides KH. Cervical length at 23 weeks of gestation: the value of Shirodkar suture for the short cervix. Ultrasound Obstet Gynecol. 1998;12:318-22.
Jorgensen AL, Alfirevic Z, Smith CT, Williamson PR. on behalf of the cerclage IPD. Meta-analysis Group. Cervical stitch (cerclage) for preventing pregnancy loss: individual patient data meta-analysis. BJOG. 2007 Dec;114(12):1460-76. Epub 2007 Sep 27.
Althuisius SM, van Geijn HP. Strategies for prevention-cervical cerclage. BJOG. 2005;112(1): 51-6.
Brown R, Gagnon R, Delisle MF. Cervical Insufficiency and Cervical Cerclage. J Obstet Gynaecol Can. 2013;35(12):1115-27.
Quinn MJ. Vaginal ultrasound and cervical cerclage: a prospective study. Ultrasound Obstet. Gynecol. 1992;2(6):410-6.
