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Published on Sep 28, 2010
TITLE: Laparoscopic Cervical Cerclage in 18-week Pregnant Uterus
The objective of the video is to demonstrate a safe, laparoscopic technique for performance of Laparoscopic Cervico-Isthmic Cerclage in the second trimester. The subject is a 19 year old G4 P0212 female at 18-weeks gestational age whose most recent delivery was at 26 weeks secondary to incompetent cervix. Although ideally performed in the twelve to fourteen week gestational age range, current management algorithms for women at risk for incompetent cervix often involve regular ultrasound surveillance of cervical length with cervical shortening used as a trigger for performance of cerclage. Many clinicians traditionally opt to perform traditional vaginal cerclage, Shirodkar or McDonald, in the mid-trimester. Because it makes sense to place the suture as high as possible, as close to the internal os where the intrinsic defect of incompetent cervix is postulated to exist, laparoscopic placement seems ideal but is often overlooked secondary to the heightened risks of operating adjacent to the dilated uterine vasculature and in confined spaces. This video demonstrates a safe and practical technique for performance of mid-trimester cervical cerclage laparoscopically.
Abs# 10.108 Authors: Greg J. Marchand, MD and Richard H. Demir, MD Tempe St. Luke's Hospital, Tempe, Arizona 85282, USA