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      Cerclaje cervicouterino transabdominal en el embarazo: A propósito de 3 casos


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          Objetivo: Evaluar la técnica de cerclaje cervicouterino transabdominal durante la gestación. Métodos: Estudio prospectivo, donde se seleccionaron 3 pacientes embarazadas, que cumplían los criterios de inclusión a las cuales se les realizó la técnica de cerclaje cervicouterino transabdominal entre las 14 y 17 semanas de gestación. Ambiente: Maternidad “Concepción Palacios”. Resultados: En los 3 casos realizados se presentó una efectividad del método del 100 %, lo cual es comparable con la experiencia internacional. Conclusión: El cerclaje cervicouterino transabdominal es una técnica reservada para pacientes bien seleccionadas que cumplan las indicaciones para su realización. Tiene buen resultado perinatal con baja incidencia de complicaciones durante su realización y durante el curso de la gestación.

          Translated abstract

          Objective: To evaluate the transabdominal cervicouterine cerclage technique during gestation. Methods: Prospective study of 3 pregnant patients that met the inclusion criteria to whom a transabdominal cervico-uterine cerclage technique was performed between 14 to 17 weeks of gestation. Setting: Maternidad “Concepcion Palacios”. Results: In the 3 cases the method effectivity was 100 %, comparable with the international experience. Conclusion: The transabdominal cervicouterine celclage is a technique reserved for selected patients that met the indications for its realization. It has a good perinatal result with low incidence of complications during the procedure and in the course of gestation.

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            Transabdominal cervicoisthmic cerclage: a reappraisal 25 years after its introduction.

            D Novy (1991)
            Most cerclage operations for cervical insufficiency are performed transvaginally. The transabdominal route is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated, or markedly scarred because of previously failed transvaginal cerclage procedures. The average gestational age at surgery was 11.5 weeks and the operation was performed after early ultrasonographic verification of fetal viability. Patients with advanced cervical effacement or dilatation in the second trimester were excluded. A 5 mm wide Mersilene band was applied in an avascular space above the junction of the cervix and the uterine isthmus without dissection or tunneling among broad ligament vessels. This simplified surgical approach resulted in little operative blood loss (mean, 75 ml; range, 50 to 200 ml). After transabdominal cervicoisthmic cerclage, 21 pregnancies in 20 patients resulted in 18 term births, one premature birth with favorable outcome, and two early fetal deaths (90% salvage rate). A review of the world literature indicated 130 pregnancies with transabdominal cervicoisthmic cerclage during pregnancy and a cumulative success rate of 89%. Preconceptional transabdominal cervicoisthmic cerclage was reported in 30 pregnancies with an overall fetal survival rate of 81%. A survey of specialists in maternal-fetal medicine indicated an increasing interest and familiarity with transabdominal cervicoisthmic cerclage since its introduction more than two decades ago although this procedure is still not widely applied in obstetric practice.
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              Validity of indications for transabdominal cervicoisthmic cerclage for cervical incompetence.

              Our purpose was to review the indications for transabdominal cervicoisthmic cerclage to determine whether it is a valid alternative to transvaginal cerclage. A retrospective review of transabdominal cerclage patients at one institution from 1978 to 1994, analysis of the indications for the transabdominal rather than the vaginal approach, and evaluation of fetal outcomes was performed. Twenty-three patients underwent 24 transabdominal cerclages. The primary indication for transabdominal cervicoisthmic cerclage was failed transvaginal cerclage in 14 patients and anatomic unsuitability for transvaginal cerclage in nine. Of the latter, five were a result of diethylstilbestrol exposure and four a result of cervical surgery. All patients were successfully delivered of one or more live babies (total 28, including two sets of twins). Two losses occurred, one after rupture of membranes at 21 weeks on the second pregnancy after cerclage placement and one intraoperative loss with herniation of the membranes. The live birth rate was 93%, compared with 18% salvage of pregnancies beyond the first trimester before the transabdominal cervicoisthmic cerclage procedure. Complications included blood loss requiring transfusion (four patients), although none of these occurred in the last 12 patients. We conclude that all the patients had a history compatible with incompetent cervix requiring a cerclage, and none were suitable candidates for a vaginal cerclage. We further conclude that with strict indications transabdominal cervicoisthmic cerclage offers a high rate of fetal salvage with a minimum of complications in patients with extremely poor obstetric histories because of cervical incompetence.

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                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                September 2009
                : 69
                : 3
                : 208-213
                [1 ] Maternidad Concepción Palacios Venezuela



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en

                Obstetrics & Gynecology
                Transabdominal cervicouterine cerclage,Cerclaje cervicouterino transabdominal


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