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Case profile
Complaint: 7+ weeks' gestation, cervical cerclage required.
Present history: 2 spontaneous abortions described in late stages.
In August 2019, the twin pregnancy at 16 weeks of pregnancy had no precipitating premature rupture of membranes, and drugs were given to induce labor.
In September 2020, the painless amniotic sac protrusion was performed at a tertiary hospital during pregnancy, and painless amniotic sac protrusion occurred again at 25 weeks of pregnancy, so the cynoss were removed and the cynostosis was miscarried.
2 months ago in a tertiary hospital hysteroscopy prompted: uterine cavity morphology is normal, No. 8 uterine expansion rod passed smoothly, the last menstrual period on April 23, 2021, menopause 30+ days self-test urine HCG positive, and then the color ultrasound prompts intrauterine early pregnancy, early pregnancy reaction is mild, no lower abdominal pain and vaginal bleeding.
Now 7 weeks pregnant, he is required to be admitted to the hospital for cervical cerclage, so the outpatient clinic is admitted to the hospital with the diagnosis of "cervical insufficiency".
Gestational history: 4 births 0, 2 spontaneous abortions in the third trimester, and 1 abortion.
Gynecological examination: the vulva and vagina are normal, the cervix is changed during pregnancy, and the vaginal internal examination is not examined.
Adjunctive tests: negative ultrasound: early intrauterine pregnancy, such as 7+ weeks' gestation, germ and heart canal beats, cervical length 2.9 cm.
Diagnosis and treatment
Diagnosis: 1, cervical insufficiency, 2, intrauterine early pregnancy.
Indications for surgery: the patient has a history of 2 late spontaneous abortions, 1 history of failed pubic sagitation, color ultrasound: intrauterine early pregnancy, and clear indications for surgery.
Summary of surgical techniques
1
The surgeon should have a good foundation in laparoscopic surgery and be familiar with the anatomy.
2
A loop tying belt is sufficient during pregnancy.
The first needle into the needle location selection is very important, along the end of the round ligament to open part of the broad ligament anterior lobe and bladder regurgitation peritoneum, in the isthmus of the uterus (equivalent to the level of the inner mouth of the cervix) blood vessel, the Mousseline ring cable tie (5 mm wide) of the needle close to the blood vessel from front to back through the uterine muscle layer, the contralateral side needs to be needled from the back to the front, the knot is hit in front of the uterus; the second needle repeats the above operation again, suture twice; intraoperative oval forceps clamp clamp on the cervix to lift the uterus.
3
After the crink tie is tightened, it is necessary to observe whether there is ischemic manifestations such as bruises in the appearance of the uterus, and if there is any occurrence, the cynical cord should be removed in time, the site should be re-selected to enter the needle, and avoid the blood vessels.
4
Circumcision of the tyre should be avoided during surgery, resulting in fracture of the isthmus of the uterus.
Postoperative management
1. Transabdominal cerclage should choose caesarean section to terminate pregnancy, the timing should be preterm or imminent premonition, or caesarean section can be performed at 39 weeks or later.
2. For patients who still have fertility requirements, the cylindrical cord can be retained; if there is no fertility requirement, the cerclage can be removed at the same time during caesarean section.
3. During the operation, the cylindrical belt is assessed without erosion, and if there is obvious erosion or cutting, the cylindrical tying belt should be removed in time.
Author: Zhang Hongjuan
Curator: Dongdong
Illustration: Author
Caption: Stand Cool Helo