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Elective and emergency transabdominal cervicoisthmic cerclage for cervical incompetence
James Hole1, Terry Tressler, Francis Martinez
1Maternal-Fetal Medicine of Central Pennsylvania, Harrisburg Hospital, Brady Building, 7th Floor, 205 South Front Street, Harrisburg, PA 17111, USA. jhole@pinnaclehealth.org
Objective:
To evaluate the success rate of transabdominal cervicoisthmic cerclage (TACIC) as an elective and emergency procedure for cervical incompetence in comparison to reported success rates for vaginal cerclage.
Study Design:
Retrospective review was performed of the hospital records of patients and their neonates who underwent TACIC for cervical incompetence by the Maternal-Fetal Medicine Service, Harrisburg Hospital. Data regarding procedure indications, maternal age, gravidity/parity, gestational age at time of placement, pregnancy outcome, delivery age and fetal weight at delivery were recorded. Comparison was made to previously reported outcomes for vaginal cerclage.
Results:
Thirteen patients underwent TACIC from July 1996 through April 2001. The overall viable delivery rate was 76.9%. Five procedures were emergency, with a viable delivery rate of 60%. Mean gestational age at delivery for this group was 34.6 weeks. The 8 elective procedures had a viable delivery rate of 87.5% and mean gestational age of 35.5 weeks. Complications from the TACIC procedure were limited to a single catheter-related urinary tract infection.
Conclusion:
In pregnancies complicated by cervical incompetence and in which Shirodkar or McDonald cerclage has previously failed or is not technically feasible, TACIC offers the possibility of a successful outcome in elective and emergency settings similar to that previously reported for vaginal cerclage.