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Qin F, Yang Y, Zhou W, Chi Y, Liu B, Chen G. Effect of different surgical routes on pregnancy outcome of history-indicated cervical cerclage. Arch Gynecol Obstet 2024; 309:1377-1386. [PMID: 37004539 PMCID: PMC10894100 DOI: 10.1007/s00404-023-07007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Abstract
OBJECTIVE To study the guiding significance of medical history on laparoscopic and vaginal cervical cerclage in the treatment of cervical incompetence and its influence on pregnancy outcome. METHODS A total of 53 cases by laparoscopic abdominal cervical cerclage (LAC group) before pregnancy and 73 cases by transvaginal cervix cerclage (TVC group) at 12-14 weeks of pregnancy were collected. Multivariate logistic regression analysis was performed on the influencing factors of delivery gestational weeks. Furthermore, the gestational weeks after cervical cerclage were compared between the two groups with high- and low-risk grades. RESULTS The number of previous uterine cavity operations in LAC group was more than that TVC group, and the costs of operation were more than TVC group. At the same time, the hospitalization days and operation time were longer than those in TVC group, and the delivery rate of cesarean section was higher than TVC group, but the total hospitalization times were less than TVC group (P < 0.05). The rate of delivery before 34 weeks of pregnancy and the incidence of premature rupture of membranes or premature labor in LAC group were lower than those in TVC group (P < 0.05). In TVC group, the increased number of prior PTB or STL and the history of cervical cerclage failure would increase the risk of premature delivery before 34 weeks of pregnancy. There was no increased risk of preterm delivery before 34 weeks of pregnancy in LAC group (P > 0.05). According to the risk level, in the high-risk group, the delivery rate of LAC group at gestational weeks < 37 weeks, < 34 weeks and < 28 weeks was lower than that of TVC group. CONCLUSION Laparoscopic cervical cerclage might be more effective in preventing premature delivery before 34 weeks of gestation, and its influence on delivery gestational weeks was not affected by related medical history. For high-risk patients with the history of prior PTB or STL and failed cerclage, laparoscopic cervical cerclage might be more effective than vaginal cervical cerclage in preventing extremely preterm before 28 weeks, premature delivery before 34 weeks and premature delivery before 37 weeks. Therefore, our limited experience suggested that LAC can be a recommended option for patients with high-risk history.
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Affiliation(s)
- Feng Qin
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Yong Yang
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Wei Zhou
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Yugang Chi
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Bao Liu
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China
| | - Gongli Chen
- Department of Gynaecology and Obstetrics, Chongqing Health Center for Women and Children, Women and Children's Hospital of Chongqing Medical University, Chongqing, 401147, China.
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Wei M, Yang Y, Jin X, Yang J, Huang D, Zhang S. A comparison of pregnancy outcome of emergency modified transvaginal cervicoisthmic cerclage performed in twin and singleton pregnancies. Arch Gynecol Obstet 2021; 303:1197-1205. [PMID: 33386955 DOI: 10.1007/s00404-020-05852-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the pregnancy outcome of emergency cerclage performed in twin and singleton pregnancies. METHODS A retrospective trial was carried out in the Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital in Zhejiang, China, from January 2013 to December 2018. A total of 89 women with acute cervical incompetence underwent the emergency cerclage. Main outcome measures were gestational age at delivery and the fetal outcome. RESULTS There were 31 twin and 58 singleton pregnancies that underwent emergency cerclage. In singleton pregnancies, gestational age at delivery (31.57 ± 6.11 vs 28.81 ± 4.34, p = 0.016), and prolongation of pregnancy (8.69 ± 6.13 vs 5.41 ± 3.72, p < 0.001) were greater, and the preterm delivery rate before 34 weeks was lower (53.4% vs 80.6%, p = 0.011) compared with twin pregnancies. Fetal weight was greater in singletons than in twins (2377.3 ± 862.1 vs 1630.3 ± 557.6, p < 0.001), but the fetal survival rate was similar. The proportion of twin gestations was significantly higher in the group with preterm delivery before 34 weeks (44.6% vs 18.2%, p = 0.011) and the proportion of previous term delivery was higher in the group with delivery at or after 34 weeks (30.3% vs 12.5%, p = 0.039). The group with preterm delivery before 34 weeks had a significantly larger size of visible membranes at cerclage than the group with delivery at or after 34 weeks (2.23 ± 0.86 vs 1.64 ± 0.80, p = 0.001). In binary logistic regression analysis, twin gestations and a larger size of visible membranes were associated with an increased risk of preterm delivery. CONCLUSION The pregnancy outcome of emergency cerclage appears to have a better prognosis in singleton pregnancies than in twin pregnancies, and twin pregnancy is a risk factor for preterm delivery.
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Affiliation(s)
- Minling Wei
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Yang Yang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Xiaoying Jin
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Jingyan Yang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Dong Huang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China
| | - Songying Zhang
- Center of Reproductive Medicine, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
- Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, 3# Qingchun East Road, Hangzhou, 310016, People's Republic of China.
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Tian S, Zhao S, Hu Y. Comparison of laparoscopic abdominal cerclage and transvaginal cerclage for the treatment of cervical insufficiency: a retrospective study. Arch Gynecol Obstet 2020; 303:1017-1023. [PMID: 33226488 DOI: 10.1007/s00404-020-05893-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 11/07/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To compare the pregnancy outcome of patients with cervical insufficiency (CI) underwent prophylactic laparoscopic abdominal cervical cerclage (LAC) and transvaginal cervical cerclage (TVC). METHODS A retrospective trial was carried out in the Department of Gynecology, Qingdao Women and Children's Hospital, Shandong Province, China. A total of 217 women with cervical insufficiency underwent the prophylactic cerclage, and the surgical approach was decided by the patients or depended on doctors' advice. The primary outcome measure was the fetal outcome. Secondary outcome measures were delivery of an infant at ≥ 34th gestational weeks, newborn birth weight, neonatal intensive care center (NICU) occupancy, and postoperative complications. Nonparametric variables were analyzed with the Mann-Whitney (U) test, and categorical type outcomes were analyzed with the Chi-square test or the Fisher's exact test. A P value < 0.05 was considered significant. Data analysis was performed using SPSS Statistics Version 19. RESULTS As of follow-up date, 154 eligible patients were included in this study, with 74 (48.1%) women in the LAC group and 80 (51.9%) in the TVC group. The total fetal survival rate in the two groups was 90.3% (139/154), of which the rate significantly higher in the LAC group compared to the TVC group (97.3% vs. 83.8%, P < 0.01). The delivery of an infant at ≥ 34th gestational weeks was significantly higher in the LAC group compared to the TVC group (94.6% vs. 71.3%, P < 0.01). Compared to the TVC group, the mean newborn birth weight was higher, and the NICU occupancy rate was less in the LAC group (3293.4 ± 542.8 g vs. 2953.6 ± 704.4 g, P = 0.002; 2.8% vs. 17.9%, P = 0.003). COMPLICATIONS No fatal surgical complications occurred in both groups. CONCLUSION In patients with cervical insufficiency, the history-indicated conception of prophylactic LAC appears to have a better pregnancy outcome than TVC.
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Affiliation(s)
- Shuxu Tian
- Department of Gynecology, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266000, Shandong, China
| | - Shuping Zhao
- Department of Gynecology, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266000, Shandong, China
| | - Youbin Hu
- Department of Gynecology, Qingdao Women and Children's Hospital, Qingdao University, Qingdao, 266000, Shandong, China.
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Wang YY, Duan H, Zhang XN, Wang S, Gao L. A Novel Cerclage Insertion: Modified Laparoscopic Transabdominal Cervical Cerclage with Transvaginal Removing (MLTCC-TR). J Minim Invasive Gynecol 2019; 27:1300-1307. [PMID: 31586476 DOI: 10.1016/j.jmig.2019.09.774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVE To report on our center's experience of a novel modified approach for laparoscopic cervical cerclage and to evaluate its safety and efficacy preliminarily. DESIGN Retrospective descriptive study. SETTING Single academic institution. PATIENTS Pregnant and nonpregnant women who underwent the modified laparoscopic transabdominal cervical cerclage with transvaginal removing (MLTCC-TR) from June 2016 to April 2019. Eligible participants had multiple adverse obstetric histories or the short cervix and were not suitable for a second transvaginal cerclage. INTERVENTIONS Preconceptional or postconceptional MLTCC-TR. MEASUREMENTS AND MAIN RESULTS A total of 24 participants (including 3 first-trimester singleton pregnant women) underwent the MLTCC-TR, giving birth to 27 infants. Among 21 women who underwent preconceptional cerclage, 26 cases of postoperational pregnancies were noted, and the incidence of term labor was 73.07%, which was significantly higher than that in the precerclage group (p <.001). Their mean gestational age at delivery was 37.21 ± 5.05 weeks. Among 3 cases of postconceptional cerclage, the mean gestational age at cerclage was 10.90 ± 2.61 weeks, and all of them had term delivery. The overall neonatal survival rate was 100% (27/27), of which 81.48% (22/27) were term infants. There were no severe perioperative complications directly related to the insertion of cerclage. CONCLUSION Our new approach of MLTCC-TR may be a relatively effective, feasible, and safe treatment for cervical insufficiency. It may be considered as an acceptable alternative to the traditional laparoscopic cervical cerclage with its superiority of transvaginal removing.
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Affiliation(s)
- Yi-Yi Wang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Drs. Y. Wang, Duan, and S. Wang)
| | - Hua Duan
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Drs. Y. Wang, Duan, and S. Wang).
| | - Xiang-Ning Zhang
- Beijing, and the Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University (Drs. Zhang and Gao), Jinan, Shandong Province, China
| | - Sha Wang
- Department of Minimally Invasive Gynecologic Center, Beijing Obstetrics and Gynecology Hospital, Capital Medical University (Drs. Y. Wang, Duan, and S. Wang)
| | - Lei Gao
- Beijing, and the Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University (Drs. Zhang and Gao), Jinan, Shandong Province, China
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Otsuki K, Ando S, Nishi T, Jimbo M. Transvaginal cervicoisthmic cerclage for patients with extremely high-risk history of preterm delivery. J Obstet Gynaecol Res 2018; 45:454-460. [DOI: 10.1111/jog.13811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 08/19/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Katsufumi Otsuki
- Department of Obstetrics and Gynecology; Showa University Koto Toyosu Hospital; Tokyo Japan
| | - Satoshi Ando
- Department of Obstetrics and Gynecology; Showa University Koto Toyosu Hospital; Tokyo Japan
| | - Takeshi Nishi
- Department of Obstetrics and Gynecology; Showa University Koto Toyosu Hospital; Tokyo Japan
| | - Masatoshi Jimbo
- Department of Obstetrics and Gynecology; Showa University Koto Toyosu Hospital; Tokyo Japan
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Gremeau AS, Corvaisier M, Bourdel N, Canis M, Gallot D, Pouly JL. Laparoscopic cervico-isthmic cerclage: About 25 cases. J Gynecol Obstet Hum Reprod 2018; 47:385-389. [PMID: 29990537 DOI: 10.1016/j.jogoh.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The purpose of this study is to report on our experience of laparoscopic cervico-isthmic cerclage. MATERIAL AND METHOD A monocentric retrospective study covering a 13-year period during which 25 cases of laparoscopic cerclage outside of pregnancy were performed, using the technique described by Dubuisson, at the University Hospital of Clermont-Ferrand. Individual patient data included pregnancy outcomes before and after cerclage and the characteristics of surgery. RESULTS The mean age of the patients was 33.9 (±4.6) years. A total of 68 pregnancies were recorded before cerclage, including 31 late miscarriages, 11 premature deliveries, with only 9 pregnancies attaining full-term. The average time of surgery was 54 (±17.5) minutes with a hospital stay of 24h. 3 minor intraoperative complications (12%) with hemorrhage <300cc were noted and managed intraoperatively. In some cases laparoscopy allowed treatment of associated pathologies (septum resection, adhesiolysis, endometriosis, ovarian drilling, tube assessment). 21 pregnancies (68% of patients) were recorded post cerclage including 5 early miscarriages and 16 cesarean deliveries with an average time taken to conceive of 11.8 months. The overall neonatal survival rate after cerclage was 76.2% versus 16.20% before surgery (p<0.0001), with a 100% neonatal survival rate beyond the 1st trimester as compared to 21.6% before cerclage (p<0.0001).
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Affiliation(s)
- Anne-Sophie Gremeau
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France.
| | - Marion Corvaisier
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France
| | - Nicolas Bourdel
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France
| | - Michel Canis
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France
| | - Denis Gallot
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France
| | - Jean Luc Pouly
- CHU Clermont-Ferrand, 1, place Lucie et Raymond Aubrac, 63100 Clermont-Ferrand cedex 1, France
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