Treatment of incompetent cervix has traditionally been surgical correction of presumed physical deficit in tissue strength with an encircling or cerclage suture, placed electively between 12 and 15 weeks or urgently in the second trimester. Despite the prolonged controversy about the role of cerclage, a randomized trial of cerclage versus bed rest or no therapy in women with atypical history of incompetent cervix has not been concluded. Until conclusive information is available, clinicians challenged to make the best management decision or each patient based on her history and cervical examination. Women with either a typical history of recurrent midtrimester delivery in the absence of another diagnosis or with atypical history accompanied by significant cervical effacement should be offered treatment with cerclage accompanied by an acknowledgement that it's efficacy is unproven. A cerclage operation may be considered during pregnancy in four clinical setting which is elective cerclage, urgent cerclage, emergency cerclage, transabdominal cerclage.
Bed Rest ; Diagnosis ; Emergencies ; Female ; Humans ; Pregnancy ; Pregnancy Trimester, Second ; Sutures ; Uterine Cervical Incompetence

Emergency cerclage is the only way to prolong pregnancy for women with advanced cervical dilatation with or without prolapsed membrane. Without cerclage, miscarriage is almost always inevitable. Emergency cerclage should be performed after considering indications, contraindications, benefits and risks. Further researches on advanced operative skill, prognostic factors and postoperative medical treatment will improve the outcome of emergency cerclage.
Abortion, Spontaneous ; Emergencies* ; Female ; Humans ; Labor Stage, First ; Membranes ; Pregnancy ; Risk Assessment ; Uterine Cervical Incompetence

Two patients, bulging fetal membrane accompanied with cervical dilatation & effacement in the late second-trimester, were treated by modified Shirodkar method. Pregnancies were prolonged effectively and viable fetuses were delivered in both cases. Our cases may help make objective decision prior to attempting cerclage placement when cervix is markedly dilated and something should be done to save pregnancy.
Cervix Uteri ; Extraembryonic Membranes* ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Uterine Cervical Incompetence*

OBJECTIVE: Our purpose was to review the clinical use of transabdominal cervicoishmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. Study design : A retrospective review was carried out of transabdominal cerclage patients at our hospital from Jan. 1999 to May. 2001. Analysis of the clinical use of transabdominal rather than the vaginal approach in some IIOC patients was performed and fetal outcomes was evaluated. RESULTS: Fifteen patients underwent transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 9 patients and anatomic unsuitability for transvaginal cerclage in 6 patients. Follow-up was conducted for all except one patient. All patients were successfully delivered of live babies by Cesarean section. Complications including blood loss requiring transfusion did not occur. However one baby died at postpartal 1 day because of congenital Tetralogy of Fallot. CONCLUSION: All patients had histories compatible with incompetent cervix requiring cerclage, and none were suitable candidates for vaginal cerclage. Our results and review of the literature confirm that Transabdominal cervicoisthmic cerclage has an important role to play for carefully selected patients.
Cesarean Section ; Female ; Follow-Up Studies ; Humans ; Pregnancy ; Retrospective Studies ; Tetralogy of Fallot ; Uterine Cervical Incompetence

Bladder stones attached to foreign bodies such as non-absorbable suture are not common. Migration of non-absorbable suture through tissues may offer stone formation. In this report, we present a case of bladder calculus in 38-year-old woman who underwent McDonald operation for incompetent cervix during pregnancy. This calculus was formed on a retained intravesical suture material, and we removed the stone containing nonabsorbable suture material transurethrally.
Adult ; Calculi ; Female ; Foreign Bodies ; Humans ; Pregnancy ; Sutures* ; Urinary Bladder Calculi* ; Urinary Bladder* ; Uterine Cervical Incompetence

OBJECTIVE: Transabdominal cervico-isthmic cerclage(TCIC) may increase the fetal salvage rate and pregnancy outcome in selected women when poor obstetric outcome is related to previously failed transvaginal cervical cerclage and an anatomically defective cervix. Our purpose was to evaluate the outcomes after transabdominal cervicoisthmic cerclage during pregnancy. STUDY DESIGN: A retrospective review was done from patients who had been received transabdominal cervicoisthmic cerclage during pregnancy at Hanyang University Medical Center from October, 1989 to April 1997. The fetal salvage rate before and after post-conceptional transabdominal cervicoisthmic cerclage were compared and analysed. RESULTS: The seventy-eight patients had 95 successful pregnancies out of a total of 97. Thus the fetal salvage rate of TCIC during in pregnancy was 97.9 %. Of 78 patients, nineteen patients had the second succesful pregnancies and repeat cesarean deliveries after TCIC. CONCLUSION: We conclude that the transabdominal cervicoisthmic cerclage during pregnancy offers a high fetal salvage rate with a minimal complications in patients with extremely poor obstertric histories as a result of cervical incompetence, where vaginal cerclage is not warranted.
Academic Medical Centers ; Cerclage, Cervical ; Cervix Uteri ; Female ; Humans ; Pregnancy ; Pregnancy Outcome* ; Pregnancy* ; Retrospective Studies ; 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

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.
Amnion ; Cerclage, Cervical* ; Cervix Uteri ; Emergencies* ; Female ; Humans ; Membranes ; Pregnancy ; Pregnancy Trimester, Second ; Rupture ; Traction ; Uterine Cervical Incompetence

Cervical incompetence is characterized by painless dilation and effacement of the cervix in the second trimester of pregnancy leading to premature rupture of membranes and preterm delivery. Various surgical and nonsurgical approaches have been advocated as treatment for incompetent cervix. The most widely used surgical methods are the Shirodkar and McDonald methods of cervical cerclage. Shirodkar method is more difficult to perform than the McDonald method, but it makes it possible for the cervix to return to more anatomically safe position. We experienced two cases of mild amniotic membrane bulging associated with incompetent cervix; one during 28(+4) weeks of pregnancy and the other during 25(+6) weeks of pregnancy. We were able to perform the emergency cervical cerclage with Shirodkar method by using the allis clamp on the edge of the incision site to traction the dilated and effaced cervix effectively, and were able to maintain the two cases of pregnancy. Both delivered healthy babies at term. So we report this case with a brief review of literature.
Amnion ; Cerclage, Cervical* ; Cervix Uteri ; Emergencies* ; Female ; Humans ; Membranes ; Pregnancy ; Pregnancy Trimester, Second ; Rupture ; Traction ; Uterine Cervical Incompetence

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