%0 Journal Article
%T Abdominal Cerclage in Twin Pregnancy after Radical Surgical Conization
%A Ioannis Kyvernitakis
%A Fred Lotgering
%A Birgit Arabin
%J Case Reports in Obstetrics and Gynecology
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/519826
%X Radical and repeated cone biopsies are associated with a high risk of spontaneous preterm birth. A 30-year-old gravida 1 presented with a spontaneous dichorionic twin pregnancy. She had a history of two radical surgical conizations. By speculum examination, no cervical tissue was detected. A history-indicated transabdominal cervicoisthmic cerclage was performed at 12 + 4/7 gestational weeks because of assumed cervicoisthmic insufficiency. The pregnancy continued until 34 + 3/7 weeks when the patient developed preeclampsia indicating Cesarean delivery. Transabdominal cerclage in twin pregnancy has rarely been described, but it may be considered in case of extreme cervical shortening after radical cervical surgery, as it would in singleton pregnancy. 1. Introduction Benson and Durfee first described transabdominal cerclage in 1965 [1]. In 1987, Wallenburg and Lotgering [2] and later Lotgering et al. [3] discussed indications for transabdominal cervicoisthmic cerclage (TAC) and suggested its use in case of suspected cervical insufficiency in women with a very short cervix to allow effective transvaginal cerclage. This may include the congenitally short or amputated cervix. At present, few case reports (Table 1) have described the use of TAC in twin pregnancies. We report on a case in which TAC was performed in a nulliparous patient with twin pregnancy and a history of two radical surgical conizations. Table 1: Summary of publications on transabdominal cerclage in twin pregnancies. 2. Presentation of the Case A 30-year-old primigravida with dichorionic/diamniotic (DC/DA) twins was referred to our unit of Marburg University at 11 weeks of gestation. Three years before, the patient had been exposed to two radical surgical conizations because of severe cervical dysplasia and carcinoma in situ, which was only completely removed after a second conization. Speculum examination showed a blind vaginal top without cervix. Transvaginal sonography (TVS) at 12 weeks demonstrated a short inner cervical length of 11.4 mm (below the 3rd centile), without funneling (Figure 1(a)). Figure 1: Inner cervical length of 11.4£¿mm at 12£¿+£¿4/7 gestational weeks before abdominal cerclage (a) and at 20 weeks after the transabdominal cervicoisthmic cerclage. The Mersilene band is shown as an echogenic structure at the cervicoisthmic junction (C) and seemed to have increased the cervical length to 25£¿mm (not shown). The patient was counseled for high risk of preterm delivery associated with short cervix and twin gestation, using the publication of Lotgering [4] as a handout. The
%U http://www.hindawi.com/journals/criog/2014/519826/