Quote:
}
}Thanks for your reply. Just to give some background to my wife's
}condition: She had two second trimester miscarriages and had been
}diagnosed as having cervical incompetence. She had a MacDonald
}suture done during her second pregnancy but still we lost the
}baby. Prior to her current third pregnancy, she had a Shirodkar
}operation. When my wife was 5 weeks pregnant, my obstetrician
}inserted the Pessary in her. I wonder if there is anything else
}that we can do to ensure the safe delivery of the baby?
If the diagnosis of cervical incompetence is secure..
(painless second trimester dilation and loss) and two cervical
cerclages have not worked, it is time for an abdominal cerclage.
This is a procedure where the abdomen is opened and the cerclage is placed
around the lower uterine segment. It is IMPOSSIBLE to get a {*filter*}l
delivery after this, and a cesarean section is required.
If you have access to a medical library you might look for this article:
Authors
Cammarano CL. Herron MA. Parer JT.
Title
Validity of indications for transabdominal cervicoisthmic cerclage for
cervical incompetence.
Source
American Journal of Obstetrics & Gynecology. 172(6):1871-5, 1995 Jun.
Abstract
OBJECTIVE: Our purpose was to review the indications for transabdominal
cervicoisthmic cerclage to determine whether it is a valid alternative to
trans{*filter*}l cerclage. STUDY DESIGN: A retrospective review of
transabdominal cerclage patients at one institution from 1978 to 1994,
analysis of the indications for the transabdominal rather than the {*filter*}l
approach, and evaluation of fetal outcomes was performed. RESULTS:
Twenty-three patients underwent 24 transabdominal cerclages. The primary
indication for transabdominal cervicoisthmic cerclage was failed
trans{*filter*}l cerclage in 14 patients and anatomic unsuitability for
trans{*filter*}l cerclage in nine. Of the latter, five were a result of
diethylstilbestrol exposure and four a result of cervical surgery. All
patients were successfully delivered of one or more live babies (total 28,
including two sets of twins). Two losses occurred, one after rupture of
membranes at 21 weeks on the second pregnancy after cerclage placement and
one intraoperative loss with herniation of the membranes. The live birth
rate was 93%, compared with 18% salvage of pregnancies beyond the first
trimester before the transabdominal cervicoisthmic cerclage procedure.
Complications included {*filter*} loss requiring transfusion (four patients),
although none of these occurred in the last 12 patients. CONCLUSION: We
conclude that all the patients had a history compatible with incompetent
cervix requiring a cerclage, and none were suitable candidates for a
{*filter*}l cerclage. We further conclude that with strict indications
transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage
with a minimum of complications in patients with extremely poor obstetric
histories because of cervical incompetence.
Hudge's pessary