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10.5005/jp-journals-10033-1299
Laparoscopic Cerclage in Pregnant and Nonpregnant Uterus: Emerging Need to change Conventional Management Approach
RevieW ARticLe

Laparoscopic Cerclage in Pregnant and Nonpregnant

Uterus: Emerging Need to change Conventional
Management Approach

Oluwole E Ayegbusi

ABSTRACT cervical dilatation followed by premature rupture or
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Cervical incompetence/insufficiency occurs in 0.1 to 1% of all prolapse of the membranes without any warning signs,
pregnancies, and, traditionally, management involves trans- such as low abdominal discomfort. This can be very
vaginal cervical cerclage. In some situations, however, such traumatic to most women, with majority usually saying,
as in extremely short cervix following cone biopsy, congenital
absent cervix, and in cases where transvaginal cerclage fails “Doctor, how do I know is coming.”
or is technically impossible, transabdominal approach via Various surgical techniques and approaches have
laparotomy is usually done. Recent data suggest that these been used to prolong pregnancy and improve perinatal
methods should be reviewed in light of the advantages seen outcome. The surgical treatment, cervical cerclage, was
in the developments of minimal access surgical techniques.
This article, therefore, compares both approaches (conven- first described in 1955 by Lash and Lash and later by
4-6
tional and laparoscopy) and, in particular, discusses the use Shirodkar. Most cerclage operations for cervical incom-
1
of laparoscopy in the management of cervical incompetence/ petence are performed transvaginally and are usually
insufficiency both in pregnant and nonpregnant uterus. done around 14 weeks.
Keywords: Cerclage, Cervical insufficiency, Laparoscopy. The current most frequently used and most simple
How to cite this article: Ayegbusi OE. Laparoscopic Cer- technique of transvaginal cerclage, a purse string suture
clage in Pregnant and Nonpregnant Uterus: Emerging Need around the body of the cervix, was described in 1957 by
to change Conventional Management Approach. World J Lap McDonald. 1,6,7
Surg 2017;10(1):35-39.
Cerclage can be performed both in the pregnant and
Source of support: Nil
the nonpregnant state. In some conditions, such as an
Conflict of interest: None extremely short, deformed, or absent cervix, the vaginal
approach does not allow placement of the cerclage,
INTRODUCTION and, hence, transabdominal cerclage via laparotomy is
The joy of motherhood is to be able to achieve spon- usually employed. The first transabdominal cerclage
taneous pregnancy and, most importantly, carry such by laparotomy was reported in 1965 by Benson et al 1,5,8 ;
pregnancy to term and deliver a healthy baby. One of subsequently, transabdominal cerclage by laparotomy has
the factors that prevents such expected natural cycle is since been done for cases that cannot be performed via
frequent midtrimester miscarriages, which sometimes is transvaginal approach with improved outcomes.
due to cervical insufficiency. The following are some of the indications for trans-
It is seen in almost 1% of all pregnancies, with a high abdominal cerclage: Congenitally short or absent cervix,
recurrence rate of 30%, and mainly results in abortion extensively amputated cervix, marked scarring of the
or premature delivery in the second and third trimester cervix, deeply notched multiple cervical defects, pene-
respectively. 1-3 trating lacerations of the fornix, subacute cervicitis, wide or
Cervical incompetence/insufficiency can be described extensive cervical conization, cervicovaginal fistulas, and
1,4
as the inability to endure a pregnancy till term due to a one or more previous transvaginal cerclage failures. The
1-3
functional or structural defect of the cervix. Most of the contraindications for transabdominal cerclage are bulging
affected women have a classic history of acute, painless membranes, ruptured membranes, intrauterine infections,
vaginal blood loss, intrauterine fetal death, labor, and life-
threatening maternal condition. The obvious disadvantage
Senior Registrar of this approach is that a laparotomy is required for the
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Department of Obstetrics and Gynaecology, Obafemi Awolowo placement of the band and for delivery ; this could be done
University Teaching Hospitals, Ile-Ife, Osun State, Nigeria twice with attending complications. It was these realities
Corresponding Author: Oluwole E Ayegbusi, Senior Registrar and others that led to the first successful cases of laparo-
Department of Obstetrics and Gynaecology, Obafemi Awolowo scopic transabdominal cerclage, which were published
University, Teaching Hospitals, Ile-Ife, Osun State, Nigeria in 1998. 9,10 Evidence now abounds in recent years with
Phone: +234805757812, e-mail: folaturabbny@gmail.com
successful reports about treating cervical insufficiency
World Journal of Laparoscopic Surgery, January-April 2017;10(1):35-39 35