Tag: cerclage

Abstract

Early prophylactic cervical cerclage for hypoplastic cervix following exposure to DES in utero, Journal de gynécologie, obstétrique et biologie de la reproduction, NCBI PubMed PMID: 16208200, 2005 Oct.
Full text: Service de Gynécologie-Obstétrique DOI: 10.1016/S0368-2315(05)82882-0, OCTOBER 2005.

AIM
Presentation of a prophylactic cerclage technique, placed in the beginning of second trimester of the pregnancy, derived from McDonald cerclage and adapted to hypoplastic cervix following exposure to DES in utero.

MATERIALS AND METHODS
Prospective study including 20 pregnant patients exposed to DES in utero and presenting a hypoplastic cervix. Study of the location of the cerclage tape in the cervix and of changes in cervical length (before and after cerclage) assessed by physical examination of the cervix and by transvaginal ultrasonography.

RESULTS
The cervix was longer after cerclage as shown by physical examination and by ultrasound. The tape was localized near the internal cervical os, its posterior portion nearer the internal cervical os than its anterior portion.

CONCLUSION
This easy-to-perform technique of cerclage of hypoplastic cervix allows the tape to be localized near the internal cervical os without colpotomy and without use of the transabdominal approach, while allowing vaginal delivery.

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Abstract

Cervical cerclage in early pregnancy, Journal of perinatology : official journal of the California Perinatal Association, NCBI PubMed PMID: 1919825, 1991 Sep.

A retrospective review of 33 patients who underwent transvaginal cervical cerclage for the treatment of an incompetent cervix from June 1984 through July 1987 was conducted. A total of 38 transvaginal cerclages were placed.

For the purposes of comparison, the patients were divided into three groups according to gestational age at the time of cerclage:

1. group 1 less than or equal to 13 weeks;
2. group 2 greater than 13 weeks, but less than 18 weeks;
3. group 3 greater than or equal to 18 weeks.

There was no difference among groups in mean age, gravidity, history of diethylstilbestrol exposure (DES), prior pregnancy loss at or before 20 weeks, or prior dilation and curettage procedure. There were 24 modified McDonald and 14 modified Shrodkar procedures performed.

The mean gestational age of cerclage placement in group 1 was earlier than in group 2 and group 3 by 3.5 and 10.5 weeks, respectively. There were no major surgical complications in any of the three groups.

The overall incidence of preterm labor and preterm birth were 48.6% and 37.8%, respectively. Analysis of variance demonstrated a trend toward differences in the incidence of preterm labor, preterm birth, and estimated gestational age at delivery, with the earlier group favored. None of these, however, reached the level of statistical significance.

Estimated blood loss, obstetric complications, mean birthweight, and mean gestational age at delivery were not statistically different for the three study groups.

The above data are discussed and support given for the safety and efficacy of cervical cerclage placement in early pregnancy when compared with the more standard recommendations of placement at from 14 to 17 weeks’ gestational age.

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• Other studies on DES and pregnancy.
• Diethylstilbestrol DES studies by topics.

Abstract

Ultrasound surveillance of the cervix during pregnancy in diethylstilbestrol-exposed offspring, Obstetrics and gynecology, NCBI PubMed PMID: 2643065, 1989 Feb.

Twenty-three diethylstilbestrol (DES)-exposed patients were evaluated through 27 pregnancies to determine their eligibility for admission to a prospective protocol that combined serial ultrasound surveillance of the lower uterine segment-cervical complex with periodic pelvic examinations to diagnose cervical incompetency.

Of these, 21 pregnant women, including seven vaginectomy patients, were matched to 84 low-risk controls to determine the following:

1. the effect of DES exposure on reproductive performance,
2. the efficacy of ultrasound selection of cerclage candidates,
3. and the influence of previous partial vaginectomy on reproductive outcome.

Five DES-exposed patients were diagnosed as having cervical incompetency and had cerclages placed. There were no missed diagnoses of cervical incompetency.

The DES-exposed patients delivered statistically earlier in gestation than did controls (268 +/- 13 versus 276 +/- 10 days). It was not evident that this difference was important clinically, as there were no neonatal deaths, very low birth weight infants, second-trimester losses, or deliveries before 252 days (36 weeks) among the study patients.

Previous vaginectomy did not affect the frequency of the diagnosis of cervical failure or the neonatal outcome. After ultrasound surveillance and treatment for incompetent cervix, a majority of our patients delivered at term without cerclage placement. Therefore, routine cerclage placement is not recommended.

Knowledge of the ultrasound criteria for diagnosing cervical incompetency is required.

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• Other studies on DES and pregnancy.
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Abstract

Management of the diethylstilbestrol-exposed pregnant patient: a prospective study, American journal of obstetrics and gynecology, NCBI PubMed PMID: 3631167, 1987 Sep.

Over a 5-year period we have managed 63 diethylstilbestrol-exposed pregnant patients with a standardized protocol requiring weekly cervical examination and decreased physical activity of the patient.

• Twenty-six patients (42%) underwent a prophylactic cerclage for a history of second-trimester loss or a hypoplastic cervix on initial clinical examination (group I).
• Thirty-six patients (58%) were followed expectantly (group II).
• Sixteen patients (44%) in group II demonstrated cervical change and required an emergency cerclage.
• Twenty-one patients were managed expectantly with no cerclage.
• The gestational age at delivery for group I was 37.7 +/- 2.80 versus 34.5 +/- 6.9 weeks for patients without a cerclage (p = 0.04).
• There were no perinatal deaths if a cerclage was performed, whereas there were five deaths (24%) in the group without cerclage.
• The five deaths occurred at a mean gestational age of 24.40 +/- 4.0 weeks and a mean birth weight of 614.00 +/- 441.73 gm.
• Patients with a hypoplastic cervix or prior reproductive loss had a better outcome with early cerclage than patients with a normal cervix followed expectantly.

We presently lack a reliable method to detect the diethylstilbestrol-exposed patient at greatest risk for perinatal loss. Based on our experience we believe that placement of a cerclage early in pregnancy should be a strong consideration.

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• Other studies on DES and pregnancy.
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Abstract

Obstetrics and gynecology, Volume 58 – Issue 1, July 1981.

The reproductive performance of 106 patients exposed in utero to diethylstilbestrol by maternal ingestion is described.

Fetal wastage is high, apparently because of spontaneous abortion during the first and second trimesters.

Recommendations – see image below – are made for preconception counseling of exposed progeny to increase fetal salvage.

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More DES DiEthylStilbestrol Resources

• Other studies on DES and pregnancy.
• Diethylstilbestrol DES studies by topics.