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

Authors

  • Y. H. Tan Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
  • S. Durai Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
  • K. Devendra Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore
  • N. Ravichandran Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20210752

Keywords:

Obstetrics, Clerclage, Pregnancy

Abstract

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.

Author Biographies

Y. H. Tan, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore

Medical officier

Dept of Obstetrics and Gynaecology

S. Durai, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore

Registrar

Dept of Obstertics and Gynaecology

K. Devendra, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore

Senior Consultant

Dept of Obstertics and Gynaecology

N. Ravichandran, Department of Obstetrics and Gynaecology, Singapore General Hospital, Singapore

Consultant

Dept of Obstertics and Gynaecology

References

ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2014;123(2 Pt 1):372.

Wang HL, Yang Z, Shen Y, Wang QL. Clinical outcome of therapeutic cervical cerclage in short cervix syndrome. Zhonghua fu Chan ke za zhi. 2018;53(1):43-6.

Brown R, Gagnon R, Delisle MF, Bujold E, Basso M, Bos H, et al. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Canada. 2013;35(12):1115-27.

Zarko A, Stampalijia T, Medley N. Cervical stitch ( cerclage) for preventing preterm birth in singleton pregnancy. Cochr Syste Rev. 2017.

Gibb, D, Saridogan, E. The role of transabdominal cervical cerclage techniques in maternity care. Obstet Gynaecol. 2016;18:117–25.

Benson RC, Durfee RB. Transabdominalcervico‐uterine cerclage during pregnancy for the treatment of cervical incompetency. Obstet Gynecol 1965;25:142–55.

Ades A, May J, Cade TJ, Umstad MP. Laparoscopic transabdominal cervical cerclage: a 6‐year experience. Austra New Zeala J Obstet Gynaecol. 2014;54(2):117-20.

Zeybek B, Hill A, Menderes G, Borahay MA, Azodi M, Kilic GS. Robot-assisted abdominal cerclage during pregnancy. J Soc Laparoendosco Surge. 2016;20(4).

Tyan P, Mourad J, Wright B. Robot assisted transabdominal Cerlcage for the prevention of preterm birth: A multicenter experience. European J Obstetr Gynecol. 2019;232:70-4.

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Published

2021-02-24

Issue

Section

Case Reports