OBJECTIVE: To predict the perinatal outcomes of emergency cervical cerclage operation we analyzed some infectious parameters before and after the operation in patients has incompetent internal os of cervix, and compared their results between one success group and one failed group. METHODS: The 13 patients with emergency cervical cerclage and the 31 patients with elective cervical cerclage included in our study. After emergency cerclage, we investigated some infectious parameters as ESR, CRP, and WBC count, every other day. And we compared these values between success and failed group. We also evaluated the difference of these results between emergency cerclage and elective cerclage operation. RESULTS: 1. There were higher values of ESR and CRP after cerclage operation in failed group than those in success group significantly (p<0.05). 2. There also had shown higher values of WBC count at 3 days after operation in failed group than those in success group significantly (p<0.05). CONCLUSION: The infection is one of the most important factors in successful perinatal outcome after emergency cerclage operation and continuous follow up in ESR, CRP and WBC counts after operation can be used to predict the perinatal outcomes in relation to incompetent internal os of cervix.
Cerclage, Cervical* ; Cervix Uteri ; Emergencies* ; Female ; Follow-Up Studies ; Humans

No abstract available.
Amniocentesis* ; Cerclage, Cervical* ; Female ; Labor Stage, First* ; Pregnancy

Transvaginal cervical cerclage for the prevention of pregnancy loss in patients with cervical incompetence is well accepted. However, there is a small subject of patients with incompetence of cervix, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage and deep cervical damage or tears in the fornices. We experienced a case of the transabdominal cervical cerclage. 'Ihe patient had a past history of deep cervical laceration due to vaginal delivery. Therefore, we present here a surgical technique of transabdominal cerdage and report it with brief review of literatures.
Cerclage, Cervical ; Cervix Uteri* ; Female ; Humans ; Lacerations ; Pregnancy

OBJECTIVE: To evaluate the usefulness of transvaginal ultrasound measurements of cervical length before and after elective prophylactic cervical cerclage in predicting preterm delivery before 32 weeks of gestation. METHODS: Women who underwent an elective cerclage operation at 14 to 19 weeks of gestation and who delivered between January 2004 and December 2009 were enrolled in this study (n=52). Ultrasonography was performed to measure cervical length before and after cerclage. The primary outcome was defined as preterm delivery before 32 weeks of gestation. A receiver operating characteristic curve was used to determine the most discriminating cut-off values of ultrasonographic cervical parameters predictive of preterm delivery before 32 weeks of gestation. RESULTS: Among the 52 patients studied, ten delivered before 32 weeks of gestation. Among the ultrasonographic cervical parameters compared, only the cervical length after cerclage was significantly different (shorter) in patients who delivered before 32 weeks of gestation (P=0.037) compared to that of those who delivered after 32 weeks of gestation in univariate and multivariate analyses (odds ratio, 0.402; 95% confidence interval, 0.174 to 0.925; P=0.021). The receiver operating characteristic curve showed that a cervical length of 25 mm or less after cerclage was predictive of preterm delivery before 32 weeks of gestation (area under curve, 0.71; 95% confidence interval, 0.56 to 0.87; P=0.029) with a sensitivity of 91.0% and a specificity of 30.0%. CONCLUSION: Patients with a cervical length less than 25 mm after elective cerclage may be at higher risk of preterm delivery before 32 weeks of gestation.
Cerclage, Cervical* ; Female ; Humans ; Multivariate Analysis ; Pregnancy ; Premature Birth ; ROC Curve ; Sensitivity and Specificity ; Ultrasonography

To evaluate the clinical efficacy of emergency cervical cerclage in the treatment of advanced cervical incompetence, a prospective clinical trial was performed in 18 patients with advanced cervical incompetence at 20 to 25 weeks gestation. Modified McDonalds operation with or without transabdominal amniocentesis was used for cervical cerclage. Pregnancy was prolonged for a sufficient time to deliver viable fetuses in 56.3% of patients. The median procedure-to-delivery interval was 8.6 (range 0.1 to 20.5) weeks for the entire group, and 13.9 (range 6.5 to 20.5) weeks for 9 patients who achieved live birth. The median gestational age at delivery was 38.6 (range 28.3 to 41.0) weeks for the live infants. The median birthweight of the live infants was 3062 g (range 1050 to 3620 g). The lack of significant matemal morbidity combined with the results for the fetus-infant supports further efforts in this area.
Amniocentesis ; Cerclage, Cervical ; Emergencies* ; Fetus ; Gestational Age ; Humans ; Infant ; Live Birth ; Pregnancy ; Prospective Studies

OBJECTIVE: To evaluate pregnancy outcomes after electrosurgical conization. METHODS: We retrospectively analyzed the outcomes of 56 singleton pregnancies after electrosurgical conization of the uterine cervix. Of the 56 cases, 25 women underwent prophylactic cerclage with McDonald procedure (cerclage group), and 31 were managed expectantly (expectant group). Pregnancy outcomes including rate of preterm delivery were compared, and the effect of potential risk factors such as depth of cone, interval between conization and pregnancy, and cervical length on the risk of preterm delivery was assessed. RESULTS: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization than those without (32.1% vs. 15.2%, p<0.001). However, preterm delivery rate was not different between the two groups (expectant group vs. cerclage group; <28 week, 6.5% vs. 8.0%, p=1.000; <34 week, 19.4% vs. 20.0%, p=1.000; <37 week, 29.0% vs. 36.0%, p=0.579). All obstetric and neonatal outcomes were similar in the two groups. Even when we confined the study subjects to 19 women (19/56, 33.9%) with cervical length less than 25 mm, the preterm delivery rate also was not significantly different between the expectant (n=7) and cerclage group (n=12). Finally, the potential risk factors for preterm delivery were not associated with risk of preterm delivery in patients with a history of electrosurgical conization. CONCLUSION: The rate of preterm delivery was significantly higher in women with a history of electrosurgical conization before pregnancy. However, prophylactic cervical cerclage did not prevent preterm delivery in these patients.
Cerclage, Cervical ; Cervix Uteri ; Conization ; Female ; Humans ; Pregnancy ; Pregnancy Outcome ; Premature Birth ; Retrospective Studies ; Risk Factors

The 68 cervical cerclage operations of incompetent internal os of the cervix(IIOC) were performed at the Taegu Catholic Medical Center from Jan. 1, 1990 to Dec. 31, 1995. The results of this study were as follows: 1. The incidence of operation for IIOC was 0.23% of total delivery. 2. Highest number of IIOC was observed in the age group of 25 to 29, and the average number of pregnancy before operation was 4.1. 3. The significant contributory factor was previous history of the induced or spontaneous abortion. 4. In all cases, cerclage method was McDonald operation. 5. The average fetal salvage rate after operation was 82.5% and from the 14th week to 16th week of gestation(43 cases), the success rate of operation was 85%. 6. The causes of operation failure were premature labor in 6 cases(55%), premature rupture of membrane in 3 cases(27%) and abortion in 2 cases(18%) in order.
Abortion, Spontaneous ; Cerclage, Cervical ; Cervix Uteri* ; Daegu ; Female ; Humans ; Incidence ; Membranes ; Obstetric Labor, Premature ; Pregnancy ; Rupture

Female ; Infant, Newborn ; Humans ; Pregnancy ; Premature Birth ; Retrospective Studies ; Risk Factors ; Cerclage, Cervical ; Cervix Uteri

A 38-year-old nulliparous woman was referred to our clinic because of cervical incompetence at 19 weeks of gestation. Trans-abdominal cervicoisthmic cerclage was performed after failure of modified Shirodkar cerclage operation in the patient at 21 weeks of gestation via a laparotomic approach. Another 38-year-old patient, who underwent loop electrosurgical excision procedure conization for treatment of cervical dysplasia 4 years ago, presented for cervical incompetence. At 18 weeks of gestation, we performed trans-abdominal laparotomic cervicoisthmic cerclage without any post-operative complications. During antenatal follow-up, there were no obstetrical co-morbidities and finally she gave birth to a healthy infant at full term by cesarean section. We report two cases of women who underwent trans-abdominal cervicoisthmic cerclage surgery because of cervical incompetence as they were not suitable for transvaginal cervical cerclage. Both patients successfully maintained their pregnancy until full term after undergoing transabdominal cervicoisthmic cerclage at more than 18 weeks of gestation.
Adult ; Cerclage, Cervical ; Cesarean Section ; Conization ; Female ; Follow-Up Studies ; Humans ; Infant ; Parturition ; Pregnancy* ; Uterine Cervical Incompetence

BACKGROUND/OBJECTIVE: After introducing transabdominal approach of cervical cerclage since 1965, several authors have reported significant increases in fetal survival rate. However, this procedure has not been widely used because its complexity of procedure and serious complications. Furthermore, there is a dilemma on the strength of the cerclage bands knots. Yet, there is no standard guidance in this approach. The purpose of this study was to suggest degree of adequate tension on the knot when tying the cerclage band on the cervico-isthmic junction during post-conceptional transabdominal cerclage and to assess whether the strength of the band is associated with uterine blood flow or pregnancy outcomes. STUDY DESIGN: Sixty-five transabdominal cervico-isthmic cerclages during pregnancy were performed for 7 years since 1989 in patients of incompetent cervix who could not be taken transvaginal cerclage. The procedures were performed with our own technique, modified technique from original Novys procedure. The cerclage used a 5mm-Mersilene band and knot was placed on the anterior side. Pre- and post-operative uterine blood flow were evaluated with Doppler velocimetry. After cesarean section at term, cerclage bands were removed and collected for measurement of bands length if they do not want further pregnancies. The relationships between strength of cerclage, length of band and pregnancy outcomes were evaluated. The effects of the bands length on the uterine blood flow were also analyzed. RESULTS: To date there have been 56 completed pregnancies in 50 patients. Among these, 21 cerclage bands were removed and collected for measurement of bands length. All pregnancies (27 pregnancies from 21 patients) were successful; the average gestational age at delivery was 38.4 weeks (range: 37-43) and mean birth weight was 3178gm (range:2670-4370). Average length of cerclage bands was 7.01cm(range:5.0-9.4), thus diameter of cerclage bands was calculated as 2.2cm. Statistically, significant positive correlation was found between the bands' length and birth weights (r=0.614, p=0.002). There were no differences between pre- and post-operative uterine blood flow regardless of cerclage bands length. CONCLUSIONS: We suggest 7cm is adequate bands length when performing transabdominal cerclage during pregnancy. Uterine blood flow was not influenced by operation. It was interesting that bands length was correlated with birth weight. It seems that tightened cerclage might preclude the adequate formation of lower uterine segment during pregnancy. Recently we use the specific Mersilene bands after marking of each centimeter interval on it, and bands are tied with 7cm in length for adequate strength of the cerclage. We propose this result also could be used when performing the pre-conceptional transabdominal cerclage.
Birth Weight ; Cerclage, Cervical ; Cesarean Section ; Female ; Gestational Age ; Humans ; Pregnancy Outcome* ; Pregnancy* ; Rheology ; Survival Rate ; Uterine Cervical Incompetence