Novel application of polypropylene sling: transvaginal cervicoisthmic cerclage in women with high risk of preterm delivery.
OBJECTIVE
To describe a novel technique of transvaginal cervicoisthmic cerclage with a polypropylene sling in prevention of preterm labor in pregnant women at high risk.


METHODS
Retrospective study (Canadian Task Force classification: III).


METHODS
University hospital (department of obstetrics and gynecology).


METHODS
Twenty-one women showing symptoms of high risk of preterm delivery: histories of pregnancy losses in the second trimester and prior failure of MacDonald's cerclage or absent portio vaginalis of the cervix. The median age of the patients was 32.8 years (range 22-39 years).


METHODS
Cerclage was performed between 12 and 16 weeks' gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. Caesarean delivery was systematically performed in all patients because the cerclage was considered to be definitive.


RESULTS
No intraoperative complications occurred. The mean operating time was 36 +/- 6 minutes (range 30-45 minutes). The mean length of stay was 1.4 +/- 0.5 days. Mean gestational age and birth weight at delivery were respectively 37.1 +/- 1.8 weeks (CI 95%: 36.4-37.9) and 2850 +/- 745 g (CI 95%: 2531-3168). The preterm birth rate was 19% (4/21). One neonatal death occurred after amniotic fluid infection at 34 weeks. Birth at less than 32 weeks occurred in one patient (4%).


CONCLUSIONS
Transvaginal cervicoisthmic cerclage with polypropylene sling may be considered as an effective and minimally invasive alternative to the transabdominal cervicoisthmic cerclage in women presenting with high risk of preterm delivery.
Deffieux
Xavier
X
Department of Obstetrics and Gynecology, Antoine Beclere Hospital, Clamart, France.
De Tayrac
Renaud
R
Louafi
Nabil
N
Gervaise
Amélie
A
Bonnet
Karen
K
Frydman
René
R
Fernandez
Hervé
H
D000328:Adult; D001672:Biocompatible Materials / Q000627:therapeutic use*; D023802:Cerclage, Cervical / Q000379:methods*; D002585:Cesarean Section; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011126:Polypropylenes / Q000627:therapeutic use*; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D019919:Prosthesis Implantation / Q000379:methods*; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery
D001672:Biocompatible Materials; D011126:Polypropylenes