- Long-term follow-up after abdominal cerclage: A population-based cohort study. [Journal Article]
- EJEur J Obstet Gynecol Reprod Biol 2017 Jan 03; 210:207-211
- CONCLUSIONS: Abdominal cerclage is associated with favorable obstetrical and neonatal outcomes in up to 5 subsequent deliveries. Long-term complications were few, and we found no difference in pregnancy outcomes or complications between cerclage placed via laparotomy or laparoscopy.
- Insuffisance cervicale et cerclage cervical. [Journal Article]
- JOJ Obstet Gynaecol Can 2016; 38(12S):S376-S390
- La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une i...
La présente directive clinique a pour but de fournir un cadre de référence que les cliniciens pourront utiliser pour identifier les femmes qui sont exposées aux plus grands risques de connaître une insuffisance cervicale, ainsi que pour déterminer les circonstances en présence desquelles la mise en place d'un cerclage pourrait s'avérer souhaitable. RéSULTATS: La littérature publiée a été récupérée par l'intermédiaire de recherches menées dans PubMed ou MEDLINE, CINAHL et The Cochrane Library en 2012 au moyen d'un vocabulaire contrôlé (p. ex. « uterine cervical incompetence ») et de mots clés appropriés (p. ex. « cervical insufficiency », « cerclage », « Shirodkar », « cerclage », « MacDonald », « cerclage », « abdominal », « cervical length », « mid-trimester pregnancy loss »). Les résultats ont été restreints aux analyses systématiques, aux essais comparatifs randomisés / essais cliniques comparatifs et aux études observationnelles. Aucune restriction n'a été appliquée en matière de date ou de langue. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusqu'en janvier 2011. La littérature grise (non publiée) a été identifiée par l'intermédiaire de recherches menées dans les sites Web d'organismes s'intéressant à l'évaluation des technologies dans le domaine de la santé et d'organismes connexes, dans des collections de directives cliniques, dans des registres d'essais cliniques et auprès de sociétés de spécialité médicale nationales et internationales.
- Cervical cerclage in advanced prolapsed fetal membranes - Case presentation. [Review]
- JMJ Med Life 2016 Jan-Mar; 9(1):70-73
- The case presentation of a transvaginal cervical cerclage performed at a 7 cm dilation in a patient in the 22nd week of pregnancy, followed by a prolongation of the pregnancy until the gestational ag...
The case presentation of a transvaginal cervical cerclage performed at a 7 cm dilation in a patient in the 22nd week of pregnancy, followed by a prolongation of the pregnancy until the gestational age of 38 weeks, was reported in the context of many similar cases managed by the authors of the article during a program of screening and prevention of preterm birth. The particularity of the case was the lack of a preterm birth in the medical history of the patient and the installation of the isthmus-cervix incompetence in the second pregnancy, after an on term pregnancy. What should be evidenced is the importance transvaginal cervical ultrasound evaluation has in the early diagnosis of this pathology during pregnancy, this being the only method of determining the efficacy of the content of the internal cervical os. Transvaginal cervical exploration has to be implemented as a screening method both in the high-risk patients and in the absence of a suggestive medical history.
- A debate about ultrasound and anatomic aspects of the cervix in spontaneous preterm birth. [Review]
- JMJ Med Life 2016 Oct-Dec; 9(4):342-347
- Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the ...
Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is required. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of cervical incompetence is low and the best prophylactic option is progesterone administration.
- Lean Umbilical Cord - a Case Report. [Journal Article]
- GFGeburtshilfe Frauenheilkd 2016; 76(11):1186-1188
- The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-o...
The "lean" umbilical cord (also known as thin-cord syndrome) is a comparatively rare anomaly of the umbilical cord, which has seldom been described in the medical literature. We report on a 35-year-old women who presented to us at 29 + 4 weeks gestation with vaginal bleeding and cervical incompetence subsequently complicated not only by premature rupture of membranes but also acute placental insufficiency requiring emergency caesarean section under general anaesthesia at 31 + 2 weeks gestation. At surgery no obvious cause for the acute placental insufficiency - such as placental abruption, cord prolapse or true knot of the umbilical cord - was found. Other possible causes such as vasa praevia or placenta praevia had previously been excluded sonographically on admission for vaginal bleeding. The only notable intraoperative finding was a macroscopically extremely thin umbilical cord.
- Bicornuate uterus is an independent risk factor for cervical os insufficiency: A retrospective population based cohort study. [Journal Article]
- JMJ Matern Fetal Neonatal Med 2016 Dec 01; :1-6
- CONCLUSIONS: Bicornuate uterus is an independent risk factor for cervical os insufficiency. This is an important finding due to the burden of the risk for midtrimester periviable birth associated with cervical incompetence.
- Role of Cervical Cerclage and Vaginal Progesterone in the Treatment of Cervical Incompetence with/without Preterm Birth History. [Journal Article]
- CMChin Med J (Engl) 2016 20th Nov; 129(22):2670-2675
- CONCLUSIONS: Cervical cerclage showed more benefits in the maternal and neonatal outcomes than vaginal progesterone therapy for women with an asymptomatic short cervix and prior PTB history, while cervical cerclage and vaginal progesterone therapies showed similar effectiveness for women with an asymptomatic short cervix but without a history of PTB.
- Robotic Cerclage in Advanced-stage Endometriosis. [Journal Article]
- JMJ Minim Invasive Gynecol 2016 Nov - Dec; 23(7):1026-1027
- CONCLUSIONS: A robotic-assisted abdominal cerclage can be performed safely and effectively in patients with advanced-stage endometriosis.
- Co-morbidity of cervical incompetence with polycystic ovarian syndrome (PCOS) negatively impacts prognosis: A retrospective analysis of 178 patients. [Journal Article]
- BPBMC Pregnancy Childbirth 2016 Oct 12; 16(1):308
- CONCLUSIONS: The cervical incompetence patients with co-morbid PCOS exhibited earlier onset gestational ages, earlier termination gestational ages and worse pregnancy outcomes. For patients with co-morbid insulin resistance, the pregnancy outcomes were worse than expected.
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- Deficiency in memory B cell compartment in a patient with infertility and recurrent pregnancy losses. [Journal Article]
- JRJ Reprod Immunol 2016; 118:70-75
- Alterations in normal balance of B cell subsets have been reported in various rheumatic diseases. In this study, we report a woman with a history of recurrent pregnancy losses (RPL) and infertility w...
Alterations in normal balance of B cell subsets have been reported in various rheumatic diseases. In this study, we report a woman with a history of recurrent pregnancy losses (RPL) and infertility who had low levels of memory B cells. A 35-year-old woman with a history of RPL and infertility was demonstrated to have increased peripheral blood CD19+ B cells with persistently low levels of memory B cell subsets. Prior to the frozen donor egg transfer cycle, prednisone and intravenous immunoglobulin G (IVIg) treatment was initiated and patient achieved dichorionic diamniotic twin pregnancies. During pregnancy, proportion (%) of switched memory B cells CD27+IgD- increased, while percent of total CD19+ B cells and CD27-IgD+ naive B cells were gradually decreased with a high dose IVIg treatment. She developed cervical incompetence at 20 weeks of gestation, received a Cesarean section at 32 weeks of gestation due to preterm labor, and delivered twin babies. B cell subset abnormalities may be associated with infertility, RPL and preterm labor, and further investigation is needed.