Акушерство, гинекология и репродукция (Apr 2020)
Experience of laparoscopic transabdominal cerclage for the correction of cervical insufficiency during pregnancy: a clinical case and literature review
Abstract
Miscarriage remains one of the most pressing challenges in modern obstetric practice, markedly impacting birth rates and women’s health. One of the manageable miscarriage causes is presented by cervical insufficiency (CI) occurring in 0.2–2.0 % of all pregnant women and in 15.5–42.7 % of those with habitual miscarriage. Both conservative and surgical treatments, such as the use of obstetric pessaries or cerclage, are applied to prevent CI-related preterm birth. Transvaginal cerclage remains the most common procedure for CI correction. However, in certain situations, transvaginal cerclage may be inapplicable or ineffective due to prior cervical scarring, conization, or other anatomical alterations. In such cases, transabdominal cerclage (TAC) can be considered as an alternative. TAC, either performed via laparotomy or laparoscopy, has demonstrated successful pregnancy outcomes in 81–89 % of cases. This article provides a brief literature review on CI surgical treatment and presents a clinical case of successful pregnancy after laparoscopic TAC in a patient with in vitro fertilization and severe cervical pathology. The patient, with a history of severe cervical pathology and multiple pregnancy losses, underwent a laparoscopic TAC at 13 weeks and 3 days of gestational age using the Cervix-set tape. The pregnancy was carried to term, and a healthy baby was delivered via planned cesarean section at gestational age of 38 weeks. Thus, laparoscopic TAC is an effective alternative for patients with complex cervical anatomy requiring more advanced surgical intervention. This procedure achieves high success rates for prolonging pregnancy and ensuring favorable outcomes while minimizing risks for both mother and child.
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