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Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion

  • Maternal Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Background

Cervical cerclage is a treatment for an incompetent cervix, the latter being a contributor to spontaneous preterm birth. There is significant difficulty with a transvaginal cerclage insertion for the absent vaginal or ecto-cervix in the mid-2nd trimester period resulting in a higher risk of late miscarriages, extremely preterm labour with increased neonatal morbidity and mortality.

Methods

A retrospective review of 5 consecutive cases managed by a surgical technique—modified high vaginal cerclage insertion at 18-20 weeks—and adjunct protocols which included vaginal progesterone use, serial infection screening and lifestyle advice, over a 12-month period ending in August 2021, is presented. Inclusion criteria included minimal or absent ecto-cervix, singleton pregnancies with an incompetent cervix attending for a vaginal cerclage whilst exclusion criteria were the usual contraindications to a cerclage insertion. Primary outcome was delivery after 34 weeks whilst seconday outcomes included maternal hemorrhage, bowel/bladder injury, chorioamnionitis and neonatal admission.

Results

A increased gestational latency of 13 gestational weeks (range 12–18). Mean gestational age at delivery was 36 weeks +1 (253 days) with a range of 241–264 days. Delivery after 34 weeks gestational age was 100% with no maternal surgical complications and corresponding neonatal outcomes.

Conclusion

There is a potential therapeutic benefit of this technique and adjunct management, in managing an incompetent mid-2nd trimester absent ecto-cervix.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Women and Children’s Hospital, Hull University Teaching Hospital NHS Trust, Hull, HU3 2JZ, UK

    T. O. Adedipe & U. O. Chukwujama

  2. Good Hope Hospital, Rectory road, Birmingham, B75 7RR, UK

    A. A. Akintunde

Authors
  1. T. O. Adedipe
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  2. A. A. Akintunde
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  3. U. O. Chukwujama
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Contributions

TOA—Study design, Data collection and Manuscript writing. AAA—manuscript writing. UOC—manuscript writing.

Corresponding author

Correspondence to T. O. Adedipe.

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Informed consent was obtained from all individual participants included in the study.

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Adedipe, T.O., Akintunde, A.A. & Chukwujama, U.O. Management of an incompetent mid-second (mid-2nd) trimester absent ecto-cervix: a case series. Cervical amplification pre-cerclage insertion. Arch Gynecol Obstet 306, 969–975 (2022). https://doi.org/10.1007/s00404-022-06694-y

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  • DOI: https://doi.org/10.1007/s00404-022-06694-y

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