Scherrenberg Heleen, Van Rompuy Anne-Sophie, Aertsen Michael, van der Merwe Johannes
Gynecology & Obstetrics, KU Leuven, Leuven, Vlaams-Brabant, Belgium.
Department of Pathology, UZ Leuven, Leuven, Vlaams-Brabant, Belgium.
BMJ Case Rep. 2025 Jul 7;18(7):e264194. doi: 10.1136/bcr-2024-264194.
Cervical cerclage, particularly transabdominal cerclage (TAC), is a last resort surgical procedure to manage cervical incompetence. Despite its high success rate, TAC carries inherent risks and can result in complications. Placenta accreta spectrum (PAS) disorder, a rare iatrogenic condition linked to previous uterine surgeries, especially caesarean sections, poses a significant risk of severe obstetric haemorrhage during delivery, often leading to maternal and neonatal morbidity.This case presents a woman in her 30s with a history of cervical insufficiency who underwent an abdominal cerclage. An uneventful pregnancy ensued, leading to a planned caesarean delivery. However, her subsequent pregnancy was complicated by cerclage erosion, uterine scar dehiscence and ultimately PAS disorder. These complications were confirmed through transvaginal ultrasound and MRI assessments prenatally and on histopathology after birth. A caesarean hysterectomy was performed at 32 weeks due to threatened preterm labour. Both mother and her infant experienced an uncomplicated postpartum and neonatal recovery.
宫颈环扎术,尤其是经腹宫颈环扎术(TAC),是治疗宫颈机能不全的一种终极手术方法。尽管其成功率很高,但TAC存在内在风险并可能导致并发症。胎盘植入谱系(PAS)疾病是一种罕见的医源性疾病,与既往子宫手术尤其是剖宫产有关,在分娩期间有严重产科出血的重大风险,常导致母婴发病。本病例介绍了一名30多岁有宫颈机能不全病史的女性,她接受了经腹宫颈环扎术。随后妊娠过程顺利,计划剖宫产分娩。然而,她随后的妊娠因宫颈环扎侵蚀、子宫瘢痕裂开并最终发生PAS疾病而复杂化。这些并发症在产前通过经阴道超声和MRI评估以及产后组织病理学检查得以确诊。由于先兆早产,在孕32周时进行了剖宫产子宫切除术。母亲和婴儿产后及新生儿恢复均顺利。