Dayan Davut, Schmid Marinus, Ebner Florian K, Janni Wolfgang, Reister Frank, Hüner Beate, Lato Krisztian, Friebe-Hoffmann Ulrike, Lukac Stefan
Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany.
Abteilung für Frauenheilkunde und Geburtshilfe, Alb-Donau Klinikum Ehingen, Ehingen (Donau), Germany.
Geburtshilfe Frauenheilkd. 2024 Oct 1;84(10):989-998. doi: 10.1055/a-2373-0639. eCollection 2024 Oct.
The aim of the study was to describe the preventive option and safety of laparoscopic transabdominal emergency cerclage in pregnant women with advanced cervical shortening after failed vaginal cerclage or in whom vaginal cerclage is no longer possible.
Laparoscopic isthmo-cervical emergency cerclage was carried out in two patients at 13+0 and 15+5 weeks of gestation (GW) respectively. Both patients had cervical shortening and it was no longer possible to expose the cervix after conization or re-conization. The attempts to carry out transvaginal cerclage were unsuccessful. The technical aspects, feasibility, safety, and pregnancy outcomes after laparoscopic transabdominal cerclage are presented here, based on two case reports.
The cerclages were placed after blunt dissection of the uterine vessels and careful introduction of a KELLY forceps through the avascular space between the ascending and descending branches of the uterine vessels without using a needle. The operating times were 93 and 134 minutes (min), respectively. The estimated blood loss during the procedure was less than 50 ml and neither perioperative nor postoperative complications occurred. The subsequent course of both pregnancies was uneventful and fetal development in both cases was normal. In the first case, the baby was delivered by secondary cesarean section following premature rupture of membranes in week 35+4 of gestation. The baby had a birthweight of 2786 g, APGAR scores of 8/9/10 and an umbilical cord arterial pH of 7.36. In the second case, delivery was by primary cesarean section in week 39+5 of gestation. The infant had a birth weight of 4160 g, APGAR scores of 5/9/10 and an umbilical cord arterial pH of 7.20.
Laparoscopic transabdominal cerclage is a safe and effective treatment option, even early in the second trimester of pregnancy, for patients in whom transvaginal cerclage is no longer possible due to anatomical factors. The method is technically very feasible and is associated with positive obstetric outcomes. The overall risk of perioperative complications is within acceptable limits.
本研究旨在描述腹腔镜经腹紧急宫颈环扎术对于阴道宫颈环扎失败或无法进行阴道宫颈环扎术的晚期宫颈缩短孕妇的预防措施及安全性。
分别对两名妊娠13⁺⁰周和15⁺⁵周的孕妇实施腹腔镜峡部 - 宫颈紧急宫颈环扎术。两名患者均有宫颈缩短，在锥切或再次锥切后无法暴露宫颈。经阴道宫颈环扎术尝试均未成功。基于两个病例报告，本文介绍了腹腔镜经腹宫颈环扎术的技术要点、可行性、安全性及妊娠结局。
在钝性分离子宫血管并通过子宫血管升支和降支之间的无血管间隙小心引入凯利钳（未使用穿刺针）后放置宫颈环扎带。手术时间分别为93分钟和134分钟。术中估计失血量少于50毫升，围手术期及术后均未发生并发症。随后的两次妊娠过程均顺利，两例胎儿发育均正常。第一例，在妊娠35⁺⁴周胎膜早破后行二次剖宫产分娩。婴儿出生体重2786克，阿氏评分8/9/10，脐动脉血pH值7.36。第二例，在妊娠39⁺⁵周行一次剖宫产分娩。婴儿出生体重4160克，阿氏评分5/9/10，脐动脉血pH值7.20。
对于因解剖因素无法进行经阴道宫颈环扎术的患者，即使在妊娠中期早期，腹腔镜经腹宫颈环扎术也是一种安全有效的治疗选择。该方法在技术上非常可行，且产科结局良好。围手术期并发症的总体风险在可接受范围内。
