Successful term delivery case of laparoscopic transabdominal cerclage performed at first trimester of gestation

Cerclaje transabdominal con abordaje laparoscópico en el primer trimestre con nacimiento a término

Preterm birth is a major cause of neonatal mortality and antenatal hospitalization.

Cervical insufficiency constitutes a risk factor for premature birth. This article aims

to describe a case of cervical insufficiency managed with laparoscopic transabdominal cerclage. A case is presented in a 37-year-old patient with septate uterus corrected by hysteroscopic surgery and a failed transvaginal cerclage with a preterm stillbirth as a result of severe prematurity in her first pregnancy. A laparoscopic transabdominal cerclage was done during her next pregnancy resulting in a healthy, full-term (38 weeks) newborn who weighed 2840 grams. Conclusions: laparoscopic cerclage in pregnancy has a high success rate with minimum complications and reduced blood loss and hospital stay. It is a feasible and safe technique for patients with cervical insufficiency and is effective in specific circumstances such as previous failed vaginal cerclage.

1. Practice Bulletin No. 159 Summary: Management of Preterm Labor. Obstet Gynecol.2016; 127(1):190-1, doi:10.1097/AOG.0000000000001260.
2. Goldenberg RL, Culhane JF, Iams JD, Romero R. Epidemiology and causes of preterm birth. Lancet Lond Engl.2008; 371(9606):75-84, doi: 10.1016/S0140-6736(08)60074-4.
3. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet Lond Engl.2012; 379(9832):2162-72, doi: 10.1016/S0140-6736(12)60820-4.
4. OMS | Informe de Acción Global sobre Nacimientos Prematuros [Internet]. WHO. [Visitado el 24 de abril de 2017]. Disponible en: http://www.who.int/pmnch/media/news/2012/preterm_birth_report/es/
5. Koullali B, Oudijk MA, Nijman T a. J, Mol BWJ, Pajkrt E. Risk assessment and management to prevent preterm birth. Semin Fetal Neonatal Med.2016; 21(2):80-8, doi:10.1016/j.siny.2016.01.005.
6. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet Gynecol.2014; 123(2 Pt 1):372-9, doi:10.1097/01.AOG.0000443276.68274.cc.
7. Brown R, Gagnon R, Delisle M-F, MATERNAL FETAL MEDICINE COMMITTEE. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can JOGC J Obstet Gynecol Can JOGC. 2013; 35(12):1115-27.
8. Sperling JD, Dahlke JD, Gonzalez JM. Cerclage Use: A Review of 3 National Guidelines. Obstet Gynecol Surv.2017; 72(4):235-41.
9. Shiber L-D, Lang T, Pasic R. First Trimester Laparoscopic Cerclage. J Minim Invasive Gynecol. 2015; 22(5):715-6, doi:10.1016/j.jmig.2015.03.007.
10. Besio R M, Besio H C. CERCLAJE CÉRVICO-ÍSTMICO TRANSABDOMINAL: SERIE CLÍNICA. Rev Chil Obstet Ginecol. 2004; 69(2):126-31.
11. Ades A, May J, Cade TJ, Umstad MP. Laparoscopic transabdominal cervical cerclage: a 6-year experience. Aust N Z J Obstet Gynaecol.2014; 54(2):117-20, doi:10.1111/ajo.12156.
12. Ades A, Dobromilsky KC, Cheung KT, Umstad MP. Transabdominal Cervical Cerclage: Laparoscopy Versus Laparotomy. J Minim Invasive Gynecol.2015; 22(6):968-73, doi:10.1016/j.jmig.2015.04.019.
13. Burger NB, Brölmann H a. M, Einarsson JI, Langebrekke A, Huirne J a. F. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: systematic review. J Minim Invasive Gynecol.2011; 18(6):696-704, doi:10.1016/j.jmig.2011.07.009.
14. Ghomi A, Rodgers B. Laparoscopic abdominal cerclage during pregnancy: A case report and a review of the described operative techniques. J Minim Invasive Gynecol.2006; 13(4):337-41, doi:10.1016/j.jmig.2006.04.002.
15. Bolla D, Raio L, Imboden S, Mueller MD. Laparoscopic Cerclage as a Treatment Option for Cervical Insufficiency. Geburtshilfe Frauenheilkd.2015; 75(8):833-8, doi:10.1055/s-0035-1557762.
16. Benson RC, Durfee RB. TRANSABDOMINAL CERVICO UTERINE CERCLAGE DURING PREGNANCY FOR THE TREATMENT OF CERVICAL INCOMPETENCY. Obstet Gynecol.1965; 25:145-55.
17. Davis G, Berghella V, Talucci M, Wapner RJ. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol.2000; 183(4):836-9, doi: 10.1067/mob.2000.108837
18. Burger NB, Einarsson JI, Brölmann HAM, Vree FEM, McElrath TF, Huirne JAF. Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study. Am J Obstet Gynecol.2012; 207(4):273.e1-12, doi:10.1155/2014/519826.
19. Huang X, Ma N, Li T-C, Guo Y, Song D, Zhao Y, et al. Simplified laparoscopic cervical cerclage after failure of vaginal suture: technique and results of a consecutive series of 100 cases. Eur J Obstet Gynecol Reprod Biol. 2016; 201:146-50.
20. Resnik, R, Robert, C, Lams, J, Lockwood CJ, Moore T, Greene MF. Creasy and Resnik’s Maternal-Fetal Medicine: Principles and Practice. 7 ed. Elsevier; 2013.
21. Fuchs F, Deffieux X, Senat M-V, Gervaise A, Faivre E, Frydman R, et al. Techniques chirurgicales de cerclage du col utérin EMC. Elsevier; 2000. p. 7. doi: 10.1016/S0000-0000(10)52958-9.