scholarly journals A successful full term delivery in a case of robotic assisted insertion of transabdominal cerclage in an obese woman with multiple uterine fibroids

2021 ◽  
Vol 10 (3) ◽  
pp. 1157
Author(s):  
Y. H. Tan ◽  
S. Durai ◽  
K. Devendra ◽  
N. Ravichandran
Keyword(s):  
Obese Woman ◽  
Uterine Fibroids ◽  
Cervical Cerclage ◽  
Invasive Approach ◽  
Robotic Assisted ◽  
Cervical Incompetence ◽  
Uncommon Presentation ◽  
Term Delivery ◽  
Complex Procedure ◽  
Full Term Delivery

Cervical incompetence is not an uncommon presentation in an obstetric emergency unit. Some of these patients will be managed with a cervical cerclage. While the management of patients presenting with first time cervical incompetence is relatively established, the management of patient with repeated cervical incompetence might require an abdominal cerclage. Abdominal cerclages can be inserted traditionally via laparotomy or via a minimally invasive approach (MIS). We present a case of an obese patient presenting with 3 previous second trimester miscarriages despite 2 cervical cerclage complicated by multiple uterine fibroids who underwent a robotic assisted insertion of transabdominal cerclage (RTAC) pre-pregnancy. She subsequently conceived spontaneously and carried the pregnancy to term and delivered a healthy baby via caesarean section. There have been multiple published studies showing that an MIS approach for abdominal cerclage insertion is safe and viable. Robotic assisted procedures allow for better visualisation and manipulation of tissue especially in patients anticipating a complex procedure. For our patient we feel that a robotic assisted procedure would be more beneficial given her profile and the complexity of her case.

scholarly journals Efficacy of an Emergency Cervical Cerclage Using Absorbable Monofilament Sutures

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Yuka Sato ◽  
Nobuhiro Hidaka ◽  
Takahiro Nakano ◽  
Saki Kido ◽  
Masahiro Hachisuga ◽  
...  
Keyword(s):  
Preterm Delivery ◽  
Spontaneous Abortion ◽  
Gestational Age ◽  
Perinatal Outcomes ◽  
Cervical Length ◽  
Cervical Cerclage ◽  
Extremely Preterm ◽  
Term Delivery ◽  
Gestational Age At Delivery ◽  
Full Term Delivery

Introduction. Although nonabsorbable woven tape has been widely used for cervical cerclage, technical difficulties that can occur with an effaced cervix because of the thickness of the tape, and the risks of local infection are two major concerns. This study investigated perinatal outcomes of pregnancies involving an emergency cervical cerclage using absorbable monofilament polydioxanone sutures, which is a narrow thread and protects against bacterial infection. Materials and Methods. We performed a chart review of patients who underwent emergency McDonald cerclage with polydioxanone sutures at our institution between 2007 and 2015. Gestational age at delivery, duration between cerclage and delivery, and neonatal prognosis were evaluated as primary outcomes. Results. Among the 23 patients (18 singleton and five twin pregnancies) evaluated, ultrasound-indicated (progressive cervical length shortening) were eight (35%) and physical examination-indicated (fetal membranes that prolapsed into the vagina or dilated cervix) were 15 patients (65%). The median gestational age at cerclage was 22+3 weeks (range, 17+5 to 25+3 weeks). Postoperative spontaneous abortion occurred in only one patient. The median gestational age at delivery was 32+5 weeks (range, 20+5 to 40+6 weeks). Extremely preterm delivery before 28 weeks of gestation occurred in four (17%) cases. Full-term delivery was achieved in 10 (42%) cases. The duration between cerclage and delivery ranged from 5 to 136 days (median, 77 days). Except for one case of spontaneous abortion, all newborns survived till hospital discharge. Conclusions. Although our series included some patients at high risk for spontaneous abortion and preterm delivery, satisfactory prolongation and favorable neonatal outcomes were achieved for most patients by using absorbable monofilament sutures, thus suggesting the efficacy of this type of suture for emergency cervical cerclage.

Frequency of Success Rate of Cervical Cerclage in Preventing Preterm Deliveries

2021 ◽  
Vol 15 (9) ◽  
pp. 2830-2832
Author(s):  
Javeria Saleem ◽  
Nadia Pervaiz ◽  
Shama Naz ◽  
Tanzeela Hassan ◽  
Afshan Rani ◽  
...  
Keyword(s):  
Success Rate ◽  
Apgar Score ◽  
Case Series ◽  
Cervical Cerclage ◽  
Cervical Incompetence ◽  
Case Series Study ◽  
Term Delivery ◽  
History Of ◽  
Series Study

Objective: Determination of success rate of cervical cerclage in prevention of preterm deliveries in patients with cervical incompetence. Study Design: Case Series study. Place and Duration of Study: Study was conducted at Khyber Teaching Hospital for a period of six months from 29 March, 2018 to 29 September, 2018. Methodology: 97 pregnant women were recruited who had a history of previous miscarriages or pre-term delivery. Cervical Cerclage was performed on these patients who were then observed till delivery to ascertain the success rate of cervical cerclage in preventing pre-term deliveries in these patients. Results: In this study mean age was 30 years with SD 8.316. 63% patients were nulli para (with previous second trimester losses) and 37% patients were multi para (with previous pre-term deliveries). 78% delivered at term and 22% delivered preterm. 80% of babies delivered with good apgar score and weight greater than 2.5 kg where as 20% of babies delivered with low apgar score and weight less than 2.5kg. Overall success rate of cervical cerclage was 80%. Conclusion: Our study concluded that success rate of cervical cerclage was 80% in preventing pre-term deliveries in patients having cervical incompetence. Keywords: Cervical Cerclage, Pre-term deliveries, Cervical incompetence, Trans-vaginal

“PREGNANCY OUTCOME IN CERVICAL INCOMPETENCE: COMPARISON OF COMBINED USE OF CERCLAGE AND ORAL PROGESTERONE VERSES HIGH DOSE OF VAGINAL PROGESTERONE”

2021 ◽  
pp. 150-153
Author(s):  
Preeti Gupta ◽  
Uma Jain ◽  
Jayshree Chimrani
Keyword(s):  
Mode Of Delivery ◽  
Neonatal Morbidity ◽  
Maternity Hospital ◽  
Cervical Length ◽  
High Dose ◽  
Spontaneous Preterm Birth ◽  
Cervical Cerclage ◽  
Cervical Incompetence ◽  
Vaginal Progesterone ◽  
Progesterone Supplementation

INTRODUCTION- Cervical insufciency, earlier known as cervical incompetence, is the inability of the cervix to maintain pregnancy till term due to structural or functional defects. Approximately 16.25% of second-trimester pregnancy losses and 2% of premature deliveries are due to cervical incompetence. OBJECTIVE- The purpose of this study was to compare the outcome of pregnancy in patients who underwent early (12-16 weeks) cervical cerclage along with oral progesterone supplementation versus those having remedied with high dose intravaginal progesterone supplementation. MATERIAL AND METHODst This retrospective study was conducted in a maternity hospital in Gwalior from 1 January 2018 to th 30 June 2021. Comprehensive history, thorough clinical examination, laboratory investigations, ultrasonography measurement of cervical length, mode of delivery, gestational age at the time of delivery, neonatal outcome, NICU admission, and other parameters were collected from the medical les. patients were divided into two groups. Ÿ Group 1(N-49) – Those who were remedied with high-dose vaginal progesterone supplementation continued uptil 34 wks of gestation. Group 2 (N-49) – Those who underwent Mc Donald type of cervical encerclage at 12-16 weeks along with oral progesterone (10 mg Duphaston twice daily dose) supplementation continued up till 34 weeks of gestation. RESULT- In our study, in the cervical cerclage group, only (4.1%) patients were delivered before 34 weeks while in the vaginal progesterone group (18.4%) patients were delivered before 34 weeks. In the cervical cerclage group (53.1%) patients were delivered between 34-37 weeks while in the vaginal progesterone group, (44.9%) of the patient delivered between 34-37 weeks. In the cervical cerclage group, the cesarean section rate was lower than only the vaginal progesterone group and admission to NICU of babies was also less (22.4%) in this group in comparison to the vaginal progesterone only group (36.7%). CONCLUSION- Our study showed that cervical cerclage plus oral progesterone supplementation in women with extremely shortened cervix signicantly decreased overall spontaneous preterm birth rates, prolonged pregnancy latency, and decreased the overall neonatal morbidity and mortality and is more effective than the vaginal progesterone group.

scholarly journals Pregnancy Outcome after Cerclage for Cervical Incompetence at a Private Hospital of Dhaka

2017 ◽  
Vol 12 (2) ◽  
pp. 78-81
Author(s):  
Shafeya Khanam ◽  
Maliha Rashid ◽  
Ayesha Siddika Purobi ◽  
Zebunnessa Parvin ◽  
Sanjoy Kumar Das ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Fetal Loss ◽  
Cervical Dilatation ◽  
Cervical Insufficiency ◽  
Miscarriage Rate ◽  
Cervical Cerclage ◽  
Cervical Incompetence ◽  
Obstetric Population

Miscarriage, particularly recurrent mid-trimester miscarriage is a distressful condition. This form of miscarriage and preterm birth appear to have some etiologies. An important etiology is cervical incompetence that describes a disorder in which painless cervical dilatation leads to recurrent second trimester pregnancy losses. Every year more than 10 million preterm birth occurs and more than 1 million baby die from this common complication of pregnancy. The incidence of true cervical insufficiency is estimated at less than 1% of the obstetric population. In the index pregnancy, findings indicative of possible cervical insufficiency include cervical funneling, cervical shortening, and overt cervical dilatation. The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with cervical incompetence. This is a retrospective observational study conducted over a period of twelve months. All cases delivered in Central Hospital were assisted by consultant obstetricians, in which 16(61.5%) out of 26 cases were delivered by caesarean section. Miscarriage rate was 11.53%. Out of the caesarean deliveries 2(12.5%) were at term and 14(87.5%) were at preterm. In this study 3(21.42%) babies born at 32nd and 33rd weeks, 6(42.85%) at 34th week and 2(14.28%) were at 35th week. There was no fetal loss. Extreme low birth weight was only one, 7(43.75%) of the babies had normal body weight for the area of study, 8 babies (50%) had low birth weight. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.Faridpur Med. Coll. J. Jul 2017;12(2): 78-81

scholarly journals Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History

2016 ◽  
Vol 129 (22) ◽  
pp. 2670-2675 ◽  
Author(s):  
Shao-Wei Wang ◽  
Lin-Lin Ma ◽  
Shuai Huang ◽  
Lin Liang ◽  
Jun-Rong Zhang
Keyword(s):  
Preterm Birth ◽  
Cervical Cerclage ◽  
Birth History ◽  
Cervical Incompetence ◽  
Vaginal Progesterone

scholarly journals Robotic Surgery in Crohn's Disease

2021 ◽  
Vol 34 (05) ◽  
pp. 286-291
Author(s):  
Drew Gunnells ◽  
Jamie Cannon
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Minimally Invasive ◽  
Patient Outcomes ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Robotic Assisted ◽  
Robotic Assisted Surgery ◽  
Minimally Invasive Operation ◽  
Complex Patients

AbstractSurgery for Crohn's disease presents unique challenges secondary to the inflammatory nature of the disease. While a minimally invasive approach to colorectal surgery has consistently been associated with better patient outcomes, adoption of laparoscopy in Crohn's disease has been limited due to these challenges. Robotic assisted surgery has the potential to overcome these challenges and allow more complex patients to undergo a minimally invasive operation. Here we describe our approach to robotic assisted surgery for terminal ileal Crohn's disease.

scholarly journals Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Stefano Cianci ◽  
Martina Arcieri ◽  
Giuseppe Vizzielli ◽  
Canio Martinelli ◽  
Roberta Granese ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pelvic Exenteration ◽  
Gynecologic Oncology ◽  
Perioperative Outcomes ◽  
Resection Margins ◽  
Salvage Procedure ◽  
Invasive Approach ◽  
Robotic Assisted ◽  
Gynecological Malignancy ◽  
Minimally Invasive Surgical

Pelvic exenteration represents the last resort procedure for patients with advanced primary or recurrent gynecological malignancy. Pelvic exenteration can be divided into different subgroup based on anatomical extension of the procedures. The growing application of the minimally invasive surgical approach unlocked new perspectives for gynecologic oncology surgery. Minimally invasive surgery may offer significant advantages in terms of perioperative outcomes. Since 2009, several Robotic Assisted Laparoscopic Pelvic Exenteration experiences have been described in literature. The advent of robotic surgery resulted in a new spur to the worldwide spread of minimally invasive pelvic exenteration. We present a review of the literature on robotic-assisted pelvic exenteration. The search was conducted using electronic databases from inception of each database through June 2021. 13 articles including 53 patients were included in this review. Anterior exenteration was pursued in 42 patients (79.2%), 2 patients underwent posterior exenteration (3.8%), while 9 patients (17%) were subjected to total exenteration. The most common urinary reconstruction was non-continent urinary diversion (90.2%). Among the 11 women who underwent to total or posterior exenteration, 8 (72.7%) received a terminal colostomy. Conversion to laparotomy was required in two cases due to intraoperative vascular injury. Complications' report was available for 51 patients. Fifteen Dindo Grade 2 complications occurred in 11 patients (21.6%), and 14 grade 3 complications were registered in 13 patients (25.5%). Only grade 4 complications were reported (2%). In 88% of women, the resection margins were negative. Pelvic exenteration represents a salvage procedure in patients with recurrent or persistent gynecological cancers often after radiotherapy. A careful patient selection remains the milestone of such a mutilating surgery. The introduction of the minimally invasive approach has led to advantages in terms of perioperative outcomes compared to classic open surgery. This review shows the feasibility of robotic pelvic exenteration. An important step forward should be to investigate the potential equivalence between robotic approaches and the laparotomic one, in terms of long-term oncological outcomes.

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