Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source
2.2. Statistical Analysis
3. Results
4. Discussions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Engelhard, I.M. Miscarriage as a traumatic event. Clin. Obstet. Gynecol. 2004, 47, 547–551. [Google Scholar] [CrossRef] [PubMed]
- Rai, R.; Regan, L. Recurrent miscarriage. Lancet 2006, 368, 601–611. [Google Scholar] [CrossRef]
- Van Beekhuizen, U.R.H. A Textbook of Gynecology for Less-Resourced Locations, 1st ed.; Sapiens Publishing: London, UK, 2012. [Google Scholar]
- Easterday, C.L.; Reid, D.E. The incompetent cervix in repetitive abortion and premature labor. N. Engl. J. Med. 1959, 260, 687–690. [Google Scholar] [CrossRef] [PubMed]
- Althuisius, S.; Dekker, G.; Hummel, P.; Bekedam, D.; Kuik, D.; van Geijn, H. Cervical Incompetence Prevention Randomized Cerclage Trial (CIPRACT): Effect of therapeutic cerclage with bed rest vs. bed rest only on cervical length. Ultrasound Obstet. Gynecol. 2002, 20, 163–167. [Google Scholar] [CrossRef] [PubMed]
- Shennan, A.; Jones, B. The cervix and prematurity: Aetiology, prediction and prevention. Semin. Fetal Neonatal. Med. 2004, 9, 471–479. [Google Scholar] [CrossRef] [PubMed]
- Berghella, V.; Rafael, T.J.; Szychowski, J.M.; Rust, O.A.; Owen, J. Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: A meta-analysis. Obstet. Gynecol. 2011, 117, 663–671. [Google Scholar] [CrossRef]
- Ades, A.; Dobromilsky, K.C.; Cheung, K.T.; Umstad, M.P. Transabdominal Cervical Cerclage: Laparoscopy Versus Laparotomy. J. Minim. Invasive Gynecol. 2015, 22, 968–973. [Google Scholar] [CrossRef]
- Benson, R.C.; Durfee, R.B. Transabdominal Cervico Uterine Cerclage during Pregnancy for the Treatment of Cervical Incompetency. Obstet. Gynecol. 1965, 25, 145–155. [Google Scholar]
- Al-Fadhli, R.; Tulandi, T. Laparoscopic abdominal cerclage. Obstet. Gynecol. Clin. N. Am. 2004, 31, 497–504. [Google Scholar] [CrossRef]
- Shin, S.J.; Chung, H.; Kwon, S.H.; Cha, S.D.; Lee, H.J.; Kim, A.R.; Hwang, I.; Cho, C.H. The Feasibility of a Modified Method of Laparoscopic Transabdominal Cervicoisthmic Cerclage During Pregnancy. J. Laparoendosc. Adv. Surg. Tech. 2015, 25, 651–656. [Google Scholar] [CrossRef]
- American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. Obstet. Gynecol. 2014, 123, 372–379. [Google Scholar] [CrossRef] [PubMed]
- Practice Committee of the American Society for Reproductive Medicine. Definitions of infertility and recurrent pregnancy loss: A committee opinion. Fertil. Steril. 2013, 99, 63. [Google Scholar] [CrossRef]
- Swingle, H.M.; Colaizy, T.T.; Zimmerman, M.B.; Morriss, F.H., Jr. Abortion and the risk of subsequent preterm birth: A systematic review with meta-analyses. J. Reprod. Med. 2009, 54, 95–108. [Google Scholar]
- Bhattacharya, S.; Townend, J.; Shetty, A.; Campbell, D.; Bhattacharya, S. Does miscarriage in an initial pregnancy lead to adverse obstetric and perinatal outcomes in the next continuing pregnancy? BJOG Int. J. Obstet. Gynaecol. 2008, 115, 1623–1629. [Google Scholar] [CrossRef]
- Vink, J.; Feltovich, H. Cervical etiology of spontaneous preterm birth. Semin. Fetal Neonatal Med. 2016, 21, 106–112. [Google Scholar] [CrossRef] [Green Version]
- Society for Maternal-Fetal Medicine (SMFM); McIntosh, J.; Feltovich, H.; Berghella, V.; Manuck, T. The role of routine cervical length screening in selected high- and low-risk women for preterm birth prevention. Am. J. Obstet. Gynecol. 2016, 215, B2–B7. [Google Scholar] [CrossRef]
- Berghella, V.; Seibel-Seamon, J. Contemporary use of cervical cerclage. Clin. Obstet. Gynecol. 2007, 50, 468–477. [Google Scholar] [CrossRef]
- Berghella, V.; Odibo, A.O.; Tolosa, J.E. Cerclage for prevention of preterm birth in women with a short cervix found on transvaginal ultrasound examination: A randomized trial. Am. J. Obstet. Gynecol. 2004, 191, 1311–1317. [Google Scholar] [CrossRef] [PubMed]
- Ades, A.; Aref-Adib, M.; Parghi, S.; Hong, P. Laparoscopic transabdominal cerclage in pregnancy: A single centre experience. Aust. N. Z. J. Obstet. Gynaecol. 2019, 59, 351–355. [Google Scholar] [CrossRef] [PubMed]
- Iavazzo, C.; Minis, E.E.; Gkegkes, I.D. Robotic assisted laparoscopic cerclage: A systematic review. Int. J. Med. Robot. 2019, 15, e1966. [Google Scholar] [CrossRef] [Green Version]
- Zeybek, B.; Hill, A.; Menderes, G.; Borahay, M.A.; Azodi, M.; Kilic, G.S. Robot-Assisted Abdominal Cerclage During Pregnancy. JSLS J. Soc. Laparoendosc. Surg. 2016, 20, e2016.00072. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Moawad, G.N.; Tyan, P.; Bracke, T.; Abi Khalil, E.D.; Vargas, V.; Gimovsky, A.; Marfori, C. Systematic Review of Transabdominal Cerclage Placed via Laparoscopy for the Prevention of Preterm Birth. J. Minim. Invasive Gynecol. 2018, 25, 277–286. [Google Scholar] [CrossRef]
- Burger, N.B.; Brolmann, H.A.; Einarsson, J.I.; Langebrekke, A.; Huirne, J.A. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: Systematic review. J. Minim. Invasive Gynecol. 2011, 18, 696–704. [Google Scholar] [CrossRef] [PubMed]
- Reitman, E.; Flood, P. Anaesthetic considerations for non-obstetric surgery during pregnancy. Br. J. Anaesth. 2011, 107, i72–i78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chang, H.K.; Seo, S.S.; Myong, J.P.; Yu, Y.L.; Byun, S.W. Incidence and costs of cervical intraepithelial neoplasia in the Korean population. J. Gynecol. Oncol. 2019, 30, e37. [Google Scholar] [CrossRef]
- Montz, F.J. Impact of therapy for cervical intraepithelial neoplasia on fertility. Am. J. Obstet. Gynecol. 1996, 175, 1129–1136. [Google Scholar] [CrossRef]
Parameter | Number of Patients (n = 299) |
---|---|
History of second trimester loss(es) | 190 (63.5%) |
Failure of TVC | 132 (69.5%) |
Cervical defect with history of cervical surgery | 4 (2.1%) |
Cervical defect with history of failure of TVC and cervical surgery | 17 (8.9%) |
Cervical defect without history of failure of TVC and cervical surgery | 37 (19.5%) |
Severe defect of cervix with or without shortened cervix | 109 (36. 5%) |
Failure of TVC | 24 (22.0%) |
Cervical defect with history of cervical surgery | 62 (56.9%) |
Cervical defect with history of failure of TVC and cervical surgery | 21 (19.3%) |
Cervical defect without history of failure of TVC and cervical surgery | 2 (1.8%) |
Parameter | Modified LTCC (n = 299) | Subgroup | |
---|---|---|---|
History of Second Trimester Loss (n = 190) | Severe Defect of Cervix with or without Shortened Cervix (n = 109) | ||
Age (years) | 32.3 (22–43) | 32.5 (22–43) | 32.2 (22-43) |
<30 | 62 (20.7%) | 40 (21.1–115%) | 22 (20.2%) |
30–35 | 185 (61.9%) | (60.5%) | 70 (64.2%) |
>35 | 52 (17.4%) | 35 (18.4%) | 17 (15.6%) |
ART | 80 (26.8%) | 46 (24.2%) | 34 (31.2%) |
OI | 4 (5.0%) | 2 (4.3%) | 2 (5.9%) |
IUI | 12 (15.0%) | 6 (13.0%) | 6 (17.6%) |
IVF | 63 (78.8%) | 37 (80.4%) | 26 (76.5%) |
ICSI | 1 (1.3%) | 1 (2.2%) | 0 (0%) |
Preterm delivery history | 185 (61.9%) | 177 (93.2%) | 8 (7.3%) |
1 | 110 (59.5%) | 103 (58.2%) | 7 (87.5%) |
2 | 58 (31.4%) | 57 (32.2%) | 1 (12.5%) |
≥3 | 17 (9.2%) | 17 (9.6%) | 0 (0%) |
Abortion history | 190 (63.5%) | 118 (62.1%) | 72 (66.1%) |
1 | 91 (47.9%) | 53 (44.9%) | 38 (52.8%) |
2 | 59 (31.1%) | 39 (33.1%) | 20 (27.8%) |
≥3 | 40 (21.1%) | 26 (22.0%) | 14 (19.4%) |
Gestational weeks at surgery | 12.5 (10.5–17.5) | 12.3 (10.5–16.3) | 13.1 (11.0–17.5) |
Twin pregnancy surgery | 36 (12.0%) | 24 (12.6%) | 12 (11.0%) |
Hemoglobin drop (g/dL) | 1.1 (0–3.4) | 1.1 (0–−3.4) | 1.2 (0–3.1) |
EBL (mL) | 70.1 (0–200) | 71.1 (0–200) | 68.6 (0–100) |
Operation time (minutes) | 47.4 (15–100) | 47.4 (15–100) | 47.2 (20–95) |
Operative complications | 0 (0%) | 0 (0%) | 0 (0%) |
Hospital stay (days) | 6.5 (3–85) | 6.9 (3–85) | 3.6 (3–30) |
Intraoperative pelvic adhesion | 113 (37.8%) | 66 (34.7%) | 47 (43.1%) |
History of cesarean section | 53 (17.7%) | 37 (19.5%) | 16 (14.7%) |
History of other abdominal surgery | 63 (21.1%) | 37 (19.5%) | 26 (23.9%) |
Parameter | Number of Patients (n = 205) | Subgroup | |
---|---|---|---|
History of Second Trimester Loss (n = 134) | Severe defect of Cervix with or without Shortened Cervix (n = 71) | ||
Delivery at 13–23 + 6 weeks | 29 (14.1%) | 17 (12.7%) | 12 (16.9%) |
Spontaneous abortion | 16 (55.2%) | 9 (52.9%) | 7 (58.3%) |
Premature rupture of membranes | 5 (17.2%) | 4 (23.5%) | 1 (8.3%) |
Infection | 4 (13.8%) | 1 (5.9%) | 3 (25.0%) |
Termination due to fetal anomaly | 3 (10.3%) | 2 (11.8%) | 1 (8.3%) |
Others | 1 (3.4%) | 1 (5.9%) | 0 (0%) |
Preterm delivery (24–36 + 6weeks) | 60 (29.3%) | 39 (29.1%) | 21 (29.6%) |
24–26 + 6 weeks | 7 (11.7%) | 6 (15.4%) | 1 (4.8%) |
27–31 + 6 weeks | 5 (8.3%) | 5 (12.8%) | 0 (0%) |
32–36 + 6 weeks | 48 (80.0%) | 28 (71.8%) | 20 (95.2%) |
Term delivery (≥37 weeks) | 116 (56.6%) | 78 (58.2%) | 38 (53.5%) |
Fetal survival rate | 176 (85.9%) | 117 (87.3%) | 59 (83.1%) |
Gestational weeks at delivery | 37 (26–40) | 36 (24–39) | 37 (25–40) |
Baby weight (g) (living newborn) | 2678 (690–4100) | 2680 (690–4100) | 2673 (840–3540) |
Low birth weight (< 2500 g) | 50 (28.4%, (50/176)) | 33 (28.2%, (33/117)) | 17 (28.8%, (17/59)) |
Requiring NICU care | 23 (13.1%, (23/176)) | 20 (17.1%, (20/117)) | 3 (5.1%, (3/59)) |
Successful next pregnancy with cerclage band in situ | 29 (14.1%) | 20 (14.9%) | 9 (12.7%) |
Cause of Preterm Delivery (24–36 + 6 Weeks) | Number of Patients (n = 60) | Subgroup | |
---|---|---|---|
History of Second Trimester Loss (n = 39) | Severe Defect of Cervix with or without Shortened Cervix (n = 21) | ||
Preterm labor | 33 (55.0%) | 21 (53.8%) | 12 (57.1%) |
24–26 + 6 weeks | 2 (6.1%) | 2 (9.5%) | 0 (0%) |
27–31 + 6 weeks | 2 (6.1%) | 2 (9.5%) | 0 (0%) |
32–36 + 6 weeks | 29 (87.9%) | 17 (81.0% | 12 (100%) |
Preterm premature rupture of membrane | 15 (25.0%) | 7 (17.9%) | 8 (38.1%) |
24–26 + 6 weeks | 2 (13.3%) | 1 (14.3%) | 1 (12.5%) |
27–31 + 6 weeks | 2 (13.3%) | 2 (28.6%) | 0 (0%) |
32–36 + 6 weeks | 11 (73.3%) | 4 (57.1%) | 7 (87.5%) |
Preeclampsia | 5 (8.3%) | 5 (12.8%) | 0 (0%) |
Others | 7 (11.7%) | 6 (15.4%) | 1 (4.8%) |
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Chung, H.; Lee, S.; Song, C.; Jang, T.-K.; Bae, J.-G.; Kwon, S.-H.; Shin, S.-J.; Cho, C.-H. Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors. J. Clin. Med. 2021, 10, 693. https://doi.org/10.3390/jcm10040693
Chung H, Lee S, Song C, Jang T-K, Bae J-G, Kwon S-H, Shin S-J, Cho C-H. Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors. Journal of Clinical Medicine. 2021; 10(4):693. https://doi.org/10.3390/jcm10040693
Chicago/Turabian StyleChung, Hyewon, Seungmee Lee, Changho Song, Tae-Kyu Jang, Jin-Gon Bae, Sang-Hoon Kwon, So-Jin Shin, and Chi-Heum Cho. 2021. "Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors" Journal of Clinical Medicine 10, no. 4: 693. https://doi.org/10.3390/jcm10040693