Outcome of 2nd Pregnancy after Transabdominal Cervicoisthmic Cerclage in Patient with Incompetent os of the Cervix

Park, Min Soo; Han, Hyun Ju; Paek, Ji Heum; Kim, Hyun Hee; Choi, Joong Sub; Park, Moon Il; Hwang, Jeong Hyae; Kim, Seung Ryong; Moon, Hyung; Chung, Sung Ro

Abstract

OBJECTIVE
The purpose of this study was to investigate the effectiveness of further successful pregnancies and prognosis after delivery where the band was not removed from a transabdominal cervicoisthmic cerclage (TCIC) after a first successful pregnancy. The candidates of TCIC were those who were diagnosed with incompetent internal os of cervix (IIOC) and either had failed to maintain pregnancy after undergoing transvaginal cerclage (TVC) or could not undergo TVC due to cervical abnormalities.
METHODS
During the period from May of 1991 until November of 2002, there were total 20 cases in which the band was not removed after previous TCIC, followed by a first successful pregnancy.
RESULTS
In the 20 patients who had undergone TCIC, the average age, average gestational age at the time of operation, average number of previous pregnancy, average number of surviving fetus, average number of preterm delivery, and average number of fetal death were 32 years old, 12.8 weeks, 5.4, 0.2, 2 and 2.2, respectively. Cesarean section was performed at an average gestational age of 37.1 weeks in which the average birth weight was 2903 g in the first born child among 19 patients. In the following pregnancies, the average age of the patients were 34 years old in which there were 17 successful deliveries out of 20 cases where the average gestational period was 35.4 weeks and an average weight of 2661 g. There was an average of 22.5 months between the time of the first and second delivery.
CONCLUSION
When the location and tension of the band had been confirmed after the first delivery in a total of 20 patients, there was a high successful delivery rate of 85% (17/20) in the next pregnancy. In this study, there was no evidence to support the complications reported in previous studies of difficulty in removal of trophoblastic tissue after abortion, dysmenorrhea, and increase in infertility associated with non removal of bands.