Article Text
Abstract
Transabdominal cerclage (TAC) is a recognised treatment for recurrent spontaneous late miscarriage or preterm birth due to cervical weakness. This can be performed via an open procedure before and during pregnancy, or a laparoscopic technique preconception. Complications include cerclage failure and suture migration. We present a case highlighting these complications where laparoscopic removal of an open TAC and replacement led to two successful term deliveries. A woman in her thirties with a fibroid uterus, adenomyosis and a history of three spontaneous mid-trimester losses, had an open TAC at 13 weeks of gestation. Preterm premature rupture of the membranes occurred shortly after and at 18 weeks of gestation she underwent surgical evacuation of the uterus. Subsequent hysteroscopy confirmed migration of the cerclage through the cervical canal. We demonstrate the application of endoscopic gynaecological surgery to remove and replace the TAC with two successful term births by Caesarean section in the ensuing pregnancies.
- pregnancy
- materno-fetal medicine
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Footnotes
Twitter @danreisel, @prenataltherapy
Contributors ES, ALD and MH conceived of the idea for the paper. MH wrote first draft of the manuscript, which was subsequently reviewed and edited by all authors. Video of procedure and ultrasound images was edited and prepared by DR, with input from the other authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.
Competing interests MH has received educational expenses from Medtronic Plc and Olympus. ALD, ES and DR report no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.