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Wide-band transabdominal cerclage for a foreshortened, incompetent cervix
M L Brodman1, F Friedman, J D Morrow
1Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, City University of New York, New York, USA.
Background:
The role of cervical cerclage in the prevention of fetal wastage due to cervical incompetence is well established. The transvaginal approach and, failing that, the transabdominal approach, provide sufficient treatment in most cases. However, the traditional techniques require adequate cervical length for placement and maintenance of the suture.
Case:
We report a new technique used for a patient with a markedly foreshortened cervix and a history of multiple second-trimester pregnancy losses despite placement of McDonald cerclages. To improve the performance of the cervix, we included the lower portion of the uterus in a 3-cm-wide Prolene mesh cerclage. During the patient's subsequent pregnancy, the mesh band funneled the lower uterine segment, creating a functionally longer cervix. The patient successfully carried the pregnancy to term and was delivered by cesarean.
Conclusion:
This variation on the transabdominal approach is useful in the management of patients with cervical incompetence who demonstrate a foreshortened cervix incapable of maintaining a traditional cervical suture.