Paily Vakkanal Paily, Ramakrishnan Soumya, Sidhik Afshana, Girijadevi Raji Raj, Sudhamma Ajithakumari, Neelankavil Joshy Joseph, Menon Usha Govindan, George Raymond, Cheriyan Sara, John Teena Eliz, Vishnu Divya, Pradeep Manu, Shafeek Suhail K
Department of Obstetrics and Gynecology, Rajagiri Hospital, Kochi, Kerala India.
J Obstet Gynaecol India. 2025 Apr;75(2):142-147. doi: 10.1007/s13224-025-02101-z. Epub 2025 Mar 12.
Transabdominal cervicoisthmic cerclages (TACIC) are currently recommended for cervical insufficiency, which is-(1) refractory to the conventional vaginally applied cervical cerclages or (2) in an anatomically short cervix. We aim to determine the feasibility and effectiveness of the cervicoisthmic cerclage applied transvaginally (TVCIC), instead of the invasive TACIC, in preventing preterm births (< 32 weeks of gestation) in women with previously failed cervical cerclages.
This retrospective case series included consecutive patients who had a history of elective cervical cerclage failure in the previous pregnancy and, therefore, underwent elective TVCIC (preconceptionally or antenatally) in the current pregnancy between 2015 and 2023 in our tertiary care setting. Fetal survival-to-discharge rate was analyzed as a secondary outcome. The TVCIC technique is performed as follows: The bladder is reflected away from the cervix by sharp dissection, leaving the utero-vesical fold of the peritoneum intact. With a posterior colpotomy, the Pouch of Douglas is entered. Bilaterally, a 5-mm Mersilene tape is passed anteroposteriorly, cranial to the uterosacral ligaments, encircling through the lateral cervical tissue, and tied posteriorly. The anterior and posterior colpotomies are then closed with interrupted sutures-burying the knot in the Pouch of Douglas. Ideally, at term, the women undergo an elective cesarean delivery, and the cerclage may be left in situ-if the woman desires future pregnancies.
In twenty-seven women with previous cervical cerclage failure, TVCIC was electively performed (twenty-three during 7-16 weeks of gestation and four preconceptionally). All but one ( = 26/27, 96.3%) of the gestations carried beyond 32 weeks of gestation, whereas 77.8% ( = 21/27) gestations completed 37 weeks. The fetal survival-to-discharge rate was 96.3% ( = 26/27). There were no procedure-related maternal or neonatal complications.
TVCIC can be further explored as an alternative to transabdominal cervicoisthmic cerclages in a larger, multicentric study in a similar population.
The online version contains supplementary material available at 10.1007/s13224-025-02101-z.
经腹宫颈峡部环扎术（TACIC）目前被推荐用于治疗宫颈机能不全，这种情况是指（1）对传统经阴道应用的宫颈环扎术无效，或（2）宫颈解剖结构短。我们旨在确定经阴道宫颈峡部环扎术（TVCIC）而非侵入性的TACIC在预防既往宫颈环扎术失败的女性发生早产（妊娠<32周）方面的可行性和有效性。
本回顾性病例系列研究纳入了在我们的三级医疗机构中，2015年至2023年期间既往妊娠有择期宫颈环扎术失败史，因此在本次妊娠中（孕前或产前）接受择期TVCIC的连续患者。将胎儿存活至出院率作为次要结局进行分析。TVCIC技术操作如下：通过锐性分离将膀胱从宫颈推开，保留子宫膀胱腹膜反折完整。经后穹窿切开进入Douglas窝。在双侧，一条5毫米的Mersilene带从前向后穿过，位于骶子宫韧带上方，环绕宫颈外侧组织，并在后方打结。然后用间断缝线关闭前后穹窿切开处，将结埋入Douglas窝。理想情况下，足月时，这些女性接受择期剖宫产，如果女性希望未来再次妊娠，环扎带可留在原位。
在27例既往宫颈环扎术失败的女性中，进行了择期TVCIC（23例在妊娠7 - 16周期间进行，4例在孕前进行）。除1例（26/27，96.3%）外，所有妊娠均超过32周，而77.8%（21/27）的妊娠完成至37周。胎儿存活至出院率为96.3%（26/27）。没有与手术相关的母体或新生儿并发症。
在类似人群中进行的更大规模、多中心研究中，TVCIC可作为经腹宫颈峡部环扎术的替代方法进一步探索。
在线版本包含可在10.1007/s13224 - 025 - 02101 - z获取的补充材料。
