Abdominal cerclage revisited.

Received: 25.11.2009; Accepted: 13.09.2011 doi: 10.1016/S0377-1237(11)60107-X • Gravida2: Six years back, spontaneous abortion at 12 weeks gestation, managed at a civil hospital. • Gravida3: Five years back, spontaneous abortion at 20 weeks gestation, managed at a peripheral military hospital. • Gravida4: Four years back, transvaginal cerclage given, spontaneous abortion at 16 weeks gestation, managed at a peripheral military hospital. • Gravida5: Three years back, spontaneous abortion at 14 weeks gestation, cerclage planned, could not be given as patient developed inevitable abortion, managed at a military tertiary care centre. • Gravida6: Three years back, transvaginal cerclage was given at 14 weeks gestation, spontaneous abortion at 18 weeks gestation, managed at a military tertiary care centre. • Gravida7: Two years back, transvaginal cerclage given at 14 weeks gestation, developed dilatation of cervix followed by prolapsed membrane with cerclage and a reinforcing second cerclage was given at 22 weeks gestation. The patient spontaneously aborted at 23 weeks gestation in civil tertiary care hospital. • Gravida8: 2008, diagnosed as a case of APLA syndrome, managed with injection low molecular weight heparin (LMWH) and ecosprin, transvaginal cerclage was given, spontaneously aborted at 24 weeks gestation, managed at our centre. • Gravida9: Present pregnancy. She reported to our centre at seven weeks four days gestation in the present pregnancy. The foetal cardiac activity and dating of pregnancy was confirmed by sonography. She was screened for APLA, diabetes, and congenital foetal anomalies, apart from standard antenatal investigations. She was started on treatment with injection LMWH, tablet ecosprin, tablet folic acid, and micronized progesterone. A combination pessary containing clindamycin with clotrimazole was also started to prevent vaginal infection. This pessary was given for a week and then repeated monthly for a week. On per speculum examination there was no portio vaginalis of cervix except for a small tag of post-lip of cervix. Her cervical length (CL) was measured by vaginal sonography at 12 week gestation and it was detected to be 13 mm (Figure 1). In view of repeated midtrimester abortions and multiple failed transvaginal cerclage, an abdominal cerclage was placed after laparotomy with 5 mm merselene tape at the level of internal optic sheath (os) with knot anterior to cervix on 14 March 2009 under spinal anaesthesia at 13 weeks gestation (Figure 2). Intra-operatively there Abdominal cerclage revisited