cervical cerclage

Uterine rupture is an obstetric crisis with potentially catastrophic fetal and maternal consequences. Uterine rupture in contemporary practice correlates with increased rates of cesarean section, with scarred uteri now being the most common etiology. We encountered a multigravida parturient with a cervical cerclage repeated in three consecutive pregnancies. She presented in early labor and removal of the cervical stitch with spontaneous progress of labor led to an unexpected cascade of events that included maternal tachycardia, fetal distress and regression of station at full dilatation. An urgent laparotomy with cesarean delivery was performed and intraoperatively we found there was hemoperitoneum and complete uterine tear extending from the cervix to the lower segment of the uterus on the left side. Repair of the tear and immediate management resulted in an uneventful postpartum recovery for both the mother and the baby. A literature search turned up just three such reported cases...

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre-and postoperative cervical length (CL), and CL at 20-24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%, < 0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20-24 weeks and adenomyosis were associated with delivery at <34 weeks' gestation following TAC (= 0.015 and = 0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20-24 weeks was a significant predictor (= 0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20-24 weeks may predict the delivery at <34 weeks' gestation following TAC.

Uterine rupture is an obstetric crisis with potentially catastrophic fetal and maternal consequences. Uterine rupture in contemporary practice correlates with increased rates of cesarean section, with scarred uteri now being the most common etiology. We encountered a multigravida parturient with a cervical cerclage repeated in three consecutive pregnancies. She presented in early labor and removal of the cervical stitch with spontaneous progress of labor led to an unexpected cascade of events that included maternal tachycardia, fetal distress and regression of station at full dilatation. An urgent laparotomy with cesarean delivery was performed and intraoperatively we found there was hemoperitoneum and complete uterine tear extending from the cervix to the lower segment of the uterus on the left side. Repair of the tear and immediate management resulted in an uneventful postpartum recovery for both the mother and the baby. A literature search turned up just three such reported cases...