TRANSABDOMINAL CERVICAL CERCLAGE DURING PREGNANCY: A Modified Technique

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Abstract

A modified surgical technique for carrying out cervical cerclage by the transabdominal route during pregnancy is presented. It is designed for the patient whose cervix is so short or damaged that the transvaginal procedure is not feasible. Basically, the method consists of a standard laparotomy at which a nylon tape is placed around the uterine isthmus medial to the uterine vessels and fixed to the anterior isthmus, Mackenrodt's ligaments, and to the insertions of the uterosacral ligaments. Results in 10 cases are reported. There were no operative or postoperative complications. One case was terminated by early spontaneous abortion and 2 by hysterotomy at 26 and 30 weeks, respectively, because of placenta previa. Seven cases were terminated by cesarean section at or near term, with delivery of 7 infants who survived. The 7 mothers had had a total of 50 prior pregnancies with only 5 living children; 4 of them had had 25 prior pregnancies with no living children. Various aspects of the procedure are discussed.

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