ABSTRACT
Cervical incompetence has been acknowledged as a significant entity predisposing patients to second-trimester miscarriage. Various surgical techniques and approaches have been used in an attempt to prolong pregnancy and improve perinatal outcome. These include transvaginal and transabdominal cervical cerclage. Some patients require the placement of a transabdominal cervicoisthmic cerclage. Should the cerclage fail or the patient have preterm premature rupture of membranes, removal of the cerclage may be necessary. As a result the application of laparoscopy for the management of cervicoisthmic cerclage removal has been advocated in an effort to limit surgical complications. We report a case of laparoscopic removal of a transabdominally placed cervical cerclage in a 32-year-old woman at 16 weeks' gestation with preterm premature rupture of membranes and inevitable miscarriage. Laparoscopy appeared to be a safe and effective means of managing the removal of this transabdominally placed cervicoisthmic cerclage.
Subject(s)
Laparoscopy , Uterine Cervical Incompetence/surgery , Abdomen , Adult , Female , Fetal Membranes, Premature Rupture , Gestational Age , Humans , Laparotomy , Pregnancy , Surgical EquipmentABSTRACT
BACKGROUND: Placenta accreta has been estimated to complicate approximately one in 2500 deliveries, resulting in significant morbidity and mortality. Conservative treatment of placenta accreta has been done in certain clinical situations when preservation of the uterus and further childbearing are desired. The Argon beam coagulator is an electrosurgical device used for hemostasis during various operations. We report its use in a case complicated by placenta accreta. CASE: A 33-year-old woman, gravida 2 para 1, with placenta accreta was treated with the Argon beam coagulator, and hemostasis was achieved in the lower uterine segment. CONCLUSION: In selected cases, the Argon beam coagulator can assist conservative treatment of placenta accreta.