Clinical implications of the unicornuate uterus with rudimentary horn

Twenty patients with unicornuate uteri were unexpectedly found during operative procedures. Of these, 18 women had unicornuate uteri with concomitant rudimentary horn and only two were without. Suspicion of ectopic pregnancy, chronic pelvic pain, or pelvic tumor, was most frequently the primary reason for admittance to hospital. Endometriosis (20%) was the most common finding in surgical procedures. Only one hematometra of the rudimentary horn was found. Two tubal pregnancies and two pregnancies in the rudimentary horn, one with rupture of the horn and one with placenta accreta in the horn, were observed. Treatment was the simple excision of the rudimentary horn in 12 cases. Fetal survival rate was 71%, prematurity 15%, and perinatal mortality 7.4% in 35 pregnancies and 27 deliveries. High incidence of breech presentation (33%) and cesarean section rate (30%) was observed. Two out of three pregnancies with cervical cerclage ended successfully. Of 15 pyelograms performed, nine (60%) showed abnormalities, the most frequently being the absence of a kidney.     

Interventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses

Objectives

The most effective preterm birth (PTB) intervention is unknown for women who are at risk of PTB due to a history of conization. The objective of this systematic review was to determine whether PTB interventions, progesterone, cerclage, and pessary decrease the risk of PTB compared to no treatment in singleton—and separately in twin—pregnancies of women with history of conization.

Effectiveness of cervical cerclage for a sonographically shortened cervix: a systematic review and meta-analysis

OBJECTIVE: The purpose of this study was to determine the effectiveness of cerclage for a shortened cervix on transvaginal ultrasound scanning in terms of the rates of preterm delivery and adverse neonatal and maternal outcomes. STUDY DESIGN: Pre-MEDLINE and MEDLINE, EMBASE, and the Cochrane Library were searched for human studies that compared cerclage placement to no cerclage on the basis of transvaginal ultrasound findings of a short cervix (< or =2.5 cm). Two authors independently determined eligibility and abstracted data. Meta-analyses were conducted when possible. RESULTS: Thirty-five studies were reviewed; 6 studies were eligible and were included in the analysis. There was no statistically significant effect of cerclage on the rates of preterm delivery (<37, <34, <32, and <28 weeks of gestation), preterm labor, neonatal mortality or morbidity, gestational age at delivery, or time to delivery. Birth weight was significantly higher with than without cerclage (P=.004). CONCLUSION: The available evidence does not support cerclage for a sonographically detected short cervix. A randomized controlled trial is needed to determine whether this intervention will reduce adverse neonatal outcomes.     

Cervical incompetence prevention randomized cerclage trial: emergency cerclage with bed rest versus bed rest alone

OBJECTIVE: The purpose of this study was to compare preterm delivery rates and neonatal morbidity/mortality rates for women with cervical incompetence with membranes at or beyond a dilated external cervical os that was treated with emergency cerclage, bed rest plus indomethacin, versus just bed rest. STUDY DESIGN: Women with cervical incompetence with membranes at or beyond a dilated external cervical os, before 27 weeks of gestation, were treated with antibiotics and bed rest and randomly assigned for emergency cerclage and indomethacin or bed rest only. RESULTS: Twenty-three women were included; 13 women were allocated randomly to the emergency cerclage and indomethacin group, and 10 women were allocated randomly to the bed rest-only group. Gestational age at time of randomization was 22.2 weeks in the emergency cerclage and indomethacin group and 23.0 weeks in the bed rest-only group. Mean interval from randomization until delivery was 54 days in the emergency cerclage and indomethacin group and 20 days in the bed rest-only group (P=.046). Mean gestational age at delivery was 29.9 weeks in the emergency cerclage and indomethacin group and 25.9 weeks in the bed rest-only group. Preterm delivery before 34 weeks of gestation was significantly lower in the emergency cerclage and indomethacin group, with 7 of 13 deliveries versus all 10 deliveries in the bed rest-only group (P=.02). CONCLUSIONS: Emergency cerclage, indomethacin, antibiotics, and bed rest reduce preterm delivery before 34 weeks compared with bed rest and antibiotics alone.     

Conservative treatment by angiographic artery embolization of an 11-week cervical pregnancy after a period of heavy bleeding

OBJECTIVE: To describe a rare case of conservative treatment of an 11-week cervical pregnancy after a period of heavy bleeding. DESIGN: Case report. SETTING: A university hospital. PATIENT(S): A 33-year-old woman was admitted to our hospital for treatment of a cervical pregnancy. Two-and-a-half years thereafter, she gave birth to a healthy baby by vaginal delivery at 38 weeks of gestation. INTERVENTION(S): Systemic methotrexate treatment, ligation of descending branches of uterine arteries, cervical cerclage, and unilateral internal iliac artery embolization. MAIN OUTCOME MEASURE(S): Transvaginal ultrasound, magnetic resonance imaging, and arteriography findings. RESULT(S): The patient was successfully treated with unilateral internal iliac artery embolization on the same side as the pregnancy in the 11th gestational week. CONCLUSION(S): After failed methotrexate and vessel ligation in cervical pregnancy, unilateral internal iliac artery embolization is an effective and conservative treatment that allows preservation of reproduction potential.     

Clinical outcomes following interval laparoscopic transabdominal cervico-isthmic cerclage placement: case series

The purpose of this report is to describe outcomes following laparoscopic transabdominal cervico-isthmic cerclage placement in cases of cervical incompetence not amenable to a conventional transvaginal procedure. We reviewed records of the first 11 patients at an academic teaching hospital who underwent laparoscopic transabdominal cerclage placement as an interval procedure, using a technique we previously first described. For all patients, the clinical course, including surgical complications and outcome of all subsequent pregnancies, is briefly described. One case was complicated by a small bowel injury secondary to concomitant extensive enterolysis. Otherwise there were no complications. Mean estimated blood loss was <40 ml. To date, 10 patients have conceived a total of 12 pregnancies following the procedure. Two pregnancies resulted in spontaneous losses at 8 weeks gestation, two in deliveries by Caesarean section at 34.5 weeks, and eight in deliveries by elective Caesarean section at 38 weeks or more. Each delivery resulted in the birth of a healthy infant. In conclusion, patients who require a transabdominal cerclage may undergo a laparoscopic interval procedure and achieve outcomes similar to those following placement via laparotomy during pregnancy.     

The prevalence and timing of cervical cerclage placement in multiple gestations.

OBJECTIVES: To investigate the prevalence and timing of cervical cerclage placement in multiple gestations. METHODS: Our perinatal database was queried for all multiple gestations delivered at Evanston Hospital from 12/95 through 12/00. This list was then cross-matched with billing and medical records for 'incompetent cervix' and 'cerclage.' The medical records of all deliveries /=14 weeks over a 5-year period. The number of patients that underwent cerclage placement was 29 or 3.6%. The mean gestational age at cerclage placement was 18.6+/-4.5 weeks (range 11-24.6). Twelve were elective or prophylactic while 17 were 'urgent' or 'emergent.' The mean gestational age for the 17 emergent cerclages was 21.4+/-2.2 weeks (range 16.6-24.6). When compared with those patients who did not undergo cerclage placement, there was no difference in maternal demographics including age, parity, or previous full-term delivery. There was a significant difference in the gestational age at delivery for the cerclage vs. no cerclage group; 29.3+/-5.6 vs. 34.4+/-4.6 weeks, respectively, and in the frequency of losses at cerclage group appeared consistent with incompetent cervix for a total of 39/802 or 4.9% rate of cervical incompetence in our multiple gestation population. CONCLUSIONS: The relatively low prevalence of cervical incompetence in our multiple gestations does not justify prophylactic cervical cerclage placement. Expectant management with serial cervical examinations starting at 16-18 weeks appears more prudent.     

宫颈环扎术治疗难免早产及难免晚期流产的疗效评价

目的:探讨宫颈环扎术在治疗难免早产及难免晚期流产中的应用价值。方法:5年间对难免早产及难免晚期流产的37例孕妇行宫颈环扎术(手术组)与同期29例未行宫颈环扎术(对照组)相比较。结果:手术组21例(56.76％)延长了孕周,最短8 d,最长56 d,16例(43.24％)失败;对照组29例入院后12 h内全部分娩。结论:宫颈环扎术在治疗难免早产及难免晚期流产时具有一定的临床价值,值得推广。     

Successful twin pregnancy after vaginal radical trachelectomy using transabdominal cervicoisthmic cerclage

The outcome of vaginal radical trachelectomy (VRT) for the management of early cervical cancer is comparable to that achieved with radical hysterectomy. Although VRT preserves the potential for pregnancy, the outcome of twin pregnancies following VRT is poor. We report a successful twin pregnancy after VRT using transabdominal cervicoisthmic cerclage.     

腹部B超联合宫颈环扎在复发性晚期流产防治中的应用价值分析

目的:探讨腹部B超联合宫颈环扎在复发性晚期流产防治中的应用价值。方法:通过分析2014年2月至2015年6月在医院分娩有复发性晚期流产史的孕妇患者112例,包括接受腹部B超联合宫颈环扎治疗的56例患者(观察组)和56例接受保守治疗的患者(对照组),观察分析两组患者治疗的临床疗效。结果:两组患者治疗结束后胎儿存活率、早产率和流产率比较差异显著,有统计学意义(P0.05);观察组患者肾上腺素、去甲肾上腺素、血管紧张素和肾素四项应激指标显著低于对照组,比较差异有统计学意义(P0.05);观察组肿瘤坏死因子-α、白细胞介素-1、白细胞介素-6三项炎症指标显著低于对照组,比较差异有统计学意义(P0.05)。结论:腹部B超联合宫颈环扎可有效预防复发性晚期流产,有效提高新生儿存活率,临床值得推广。