A case of transabdominal cervical cerclage at 17 weeks of gestation in a patient with a history of cervical conization

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  • OKAMURA Naoya
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • KATO Toru
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • MATSUOKA Michie
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • FUJII Yuta
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • HARADA Kayoko
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • TANAKA Hiroyuki
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • SAWAI Hideaki
    Department of Obstetrics and Gynecology, Hyogo College of Medicine
  • SHIBAHARA Hiroaki
    Department of Obstetrics and Gynecology, Hyogo College of Medicine

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Other Title
  • 子宮頸部円錐切除術既往のある妊娠17週の妊婦に対して経腹的子宮頸管縫縮術を施行し生児を獲得した1例
  • シキュウ ケイブ エンスイ セツジョジュツ キオウ ノ アル ニンシン 17シュウ ノ ニンプ ニ タイシテ ケイ フクテキ シキュウケイカン ヌイチジミジュツ オ シコウ シ セイジ オ カクトク シタ 1レイ

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Abstract

<p>Transabdominal cervical cerclage (TAC) is more difficult than transvaginal cervical cerclage (TVC) and often performed at 9-12 weeks of gestation. We performed TAC at 17 weeks of gestation in a patient with a history of cervical conization. The patient was 40 years old, gravida three para zero, and became pregnant naturally. She has a history of cervical conization for CIN3 and spontaneous abortion at six and 11 weeks of gestation after operation. The cervical length was 26 mm at 12 weeks of gestation and 14 mm at 15 weeks and six days of pregnancy and It is difficult to perform for TVC because of shortended cervix ; she was then hospitalized. We performed TAC at 17 weeks and two days of pregnancy because the short cervical length made TVC difficult. A large abdominal incision was needed to obtain the uterine surgical field at 17 weeks of gestation. The surgery was performed using transvaginal ultrasound examination. The postoperative course was favorable and she was discharged at 19 weeks of gestation. At 29 weeks and six days of pregnancy, the cervical length was 15 mm ; she was hospitalized again. The subsequent pregnancy course was favorable, and cesarean section was performed at 37 weeks and five days of pregnancy ; she successfully delivered a healthy baby. The first case in japan to perform TAC at 17 weeks gestation. Although obtaining the TAC surgical field was difficult at 17 weeks of gestation, we performed TAC using transvaginal ultrasound. Although TAC indications must consider the significant invasiveness, we would like to improve perinatal prognosis to do TAC. [Adv Obstet Gynecol, 73 (3) : 230-237, 2021 (R3.8)]</p>

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