Transvaginal cerclage under ultrasound guidance in cases of severe cervical hypoplasia

Transabdominal cervical cerclage has been advocated for patients with cervical incompetence whose cervix is flush against the vaginal wall. Although several series of successful transabdominal cerclage have been reported, the morbidity of this technique precludes its routine use. We describe five pregnancies in four patients with extreme cervical hypoplasia who underwent successful prophylactic transvaginal cerclage placement at 12-13 weeks' gestation. All patients had a history of intrauterine diethylstilbestrol exposure, and three patients had also undergone cervical conization. In each case, using continuous transabdominal ultrasound guidance, the supravaginal cervix was dissected and two nonabsorbable sutures were placed through the cervix at right angles at the level of the anatomical internal os. There were no perioperative complications, and except for one patient who developed severe preeclampsia at 33 weeks, all patients delivered at term. We believe that the use of ultrasound in cases of severe cervical hypoplasia allows safe transvaginal cerclage placement, obviating the need for abdominal cerclage.