Laparoscopic abdominal cerclage in a patient with recurrent miscarriages abortions – case report

Czech version

Authors: K. Huml ¹; L. Kantor ²; M. Procházka ³; M. Studničková ¹; R. Pilka ¹
Authors‘ workplace: Porodnicko-gynekologická klinika FN a LF UP, Olomouc, přednosta prof. MUDr. R. Pilka, Ph. D. ¹; Novorozenecké oddělení FN a LF UP, Olomouc, primář MUDr. L. Kantor, Ph. D. ²; Ústav lékařské genetiky FN a LF UP, Olomouc, přednosta doc. MUDr. M. Procházka, Ph. D. ³
Published in: Ceska Gynekol 2016; 81(1): 58-62

Overview

Objective:
The use of laparoscopic abdominal cerclage in a patient with habitual miscarriage.

Design:
Case report and literature review.

Setting:
Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Department of Neonatology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc.

Case report:
The patient is a 37 years old woman with a history of recurrent miscarriages. She had one labor at term and six pregnancies that were lost in the second trimester despite McDonald cerclages. Abdominal cerclages are necessary when the standard transvaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. The disadvantage of the transabdominal approach is that it requires at least 2 laparotomies with significant morbidity and hospital stays. We discuss a case of abdominal cerclage performed laparoscopically. A 5 mm Mersilene tape was placed laparoscopically at the level of the internal os as an interval procedure. We feel it offers less morbidity and in the proper hands eliminates or significantly shortens hospital stays. Subsequent pregnancy was terminated at 28 weeks by caesarean section after premature rupture of membranes.

Conclusion:
Laparoscopic abdominal cerclage seems to be relatively effective option for the prevention of habitual abortion patients, which fail conventional surgical procedures in dealing with cervical incompetence. The success of subsequent full term pregnancy is given as 70%.

KEYWORDS:
cerclage, laparoscopy, cervical incompetence

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