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Korean Journal of Obstetrics & Gynecology 2003;46(3):624-631.
Published online March 1, 2003.
The Comparison between Modified Transvaginal Cerclage and Transabdominal Cervicoisthmic Cerclage after a failure of Previous Transvaginal Cerclage in Incompetent Internal Os of Cervix Patients.
Joong Sub Choi, Min Soo Park, Young Jae Kim, Eun Koung Bae, Ji Heum Paek, Moon Il Park, Jeong Hyae Hwang, Seung Ryong Kim, Hyung Moon, Sung Ro Chung
1Department of Obstetrics and Gynecology, College of Medicine, Hanyang University, Seoul, Korea.
2Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
OBJECTIVE
Incompetent internal os of cervix is one of the most common causes of midtrimester abortion in which interventions such as, transvaginal cerglage and transabdominal cervicoisthmic cerclage (TCIC) have been performed to prolong pregnancy. Transabdominal cerclage is beneficial in treating patients with cervices that are either extremely short, congenitally deformed, deeply lacerated after operative delivery, or markedly scarred because of previously failed transvaginal cerclage procedures. Due to technical difficulties and the fact that a cesarean section is necessary for delivery, has not been a procedure easily adopted. The purpose of our study was to compare the effectiveness of selected Modified McDonald cerclage (MTVC) and TCIC was compared in patients who had history of a previously failed transvaginal cerclage in other hospital. MATERIALS AND METHODS: Pregnancy outcomes of 13 patients who underwent TCIC from November 1997 to January 2002 and those of 28 patients who underwent MTVC from January 2000 to January 2002 were compared. Statistical analysis was done using Chi-square test and Mann-Whitney. RESULTS: The fetal salvage rates for total 13 cases of TCIC and 28 cases of MTVC were 100% (13/13) and 85.7% (24/28), respectively. The fetal salvage rates between these two groups were not statistically different. The mean gestational age at the time of operation in TCIC group was 13.15 (+/-1.63) weeks, mean gestational weeks delayed until delivery was 23.85 (+/-3.24) weeks and mean fetal body weight was 2780.77 (+/-667.33) gm. Comparably, the mean gestational age at the time of operation in MTVC group was 15.00 (+/-2.05) week, mean gestational weeks delayed until delivery was 9.96 (+/-6.65) week and mean fetal body weight was 2530 (+/-1071.26) gm. CONCLUSION: In patients who had a history of failure of TVC, the effectiveness of TCIC and MTVC had no statistical significance. Treatment with MTVC should be considered since TCIC is technically difficult and requires cesarean section.
Key Words: Modified transvaginal cerclage, Transabdominal cervicoisthmic cerclage


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