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Laparoscopic Transabdominal Cerclage Despite the Absence of Prior Pregnancy Loss: A Case of Profound Acquired
Kensuke Suzuki1, Takayuki Iriyama1, Gentaro Izumi1
1Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
Repeated cervical conization can result in cervical shortening and substantial structural and functional impairment. A 35-year-old woman developed cervical stenosis and hematometra after undergoing two conizations. The vaginal cervix and external os were unidentifiable, drainage was unsuccessful, and laparoscopy-assisted recanalization proved technically challenging as multiple false passages formed before achieving uterine access. Repeated dilation maintained cervical patency, and intrauterine insemination achieved pregnancy after cervical factor infertility was diagnosed. At 9 weeks of gestation, the residual endocervical glandular region measured 11.9 mm, and the vaginal cervix was nearly absent. As the cumulative clinical course demonstrated severe anatomical disruption that precluded transvaginal cerclage, laparoscopic transabdominal cervicoisthmic cerclage was performed at 13 weeks and 3 days of gestation. Uterine artery pulsatility indices remained within the reference range. A 2114-g infant was delivered by cesarean section at 37 weeks and 5 days. Severe anatomical cervical defects may warrant transabdominal cerclage beyond conventional history-based indications.
Repeated cervical conization can result in cervical shortening and substantial structural and functional impairment. A 35-year-old woman developed cervical stenosis and hematometra after undergoing two conizations. The vaginal cervix and external os were unidentifiable, drainage was unsuccessful, and laparoscopy-assisted recanalization proved technically challenging as multiple false passages formed before achieving uterine access. Repeated dilation maintained cervical patency, and intrauterine insemination achieved pregnancy after cervical factor infertility was diagnosed. At 9 weeks of gestation, the residual endocervical glandular region measured 11.9 mm, and the vaginal cervix was nearly absent. As the cumulative clinical course demonstrated severe anatomical disruption that precluded transvaginal cerclage, laparoscopic transabdominal cervicoisthmic cerclage was performed at 13 weeks and 3 days of gestation. Uterine artery pulsatility indices remained within the reference range. A 2114-g infant was delivered by cesarean section at 37 weeks and 5 days. Severe anatomical cervical defects may warrant transabdominal cerclage beyond conventional history-based indications.
