Prophylactic Transvaginal Cervical Cerclage: Treatment Of Cervical Incompetence And Its Clinical Outcomes Analysis

Background Cervical incompetence(CIC)has been defined as the inability of the uterine cervix to retain a pregnancy.Usually.women with this disorder have repetitive late second-trimester losses in which painless cervical dilatation and subsequent delivery of an otherwise normal fetus usually occurs between 18 and 22 weeks of gestation and the incidence is 0.1-2%.However,it is the cause of about 15%miscarriages in whom has habitual abortion during 16 and 28 weeks of gestation.Unfortunately there is no diagnostic test or proven criteria for cervical incomptence. Diagnosis is usually made retrospectively based on a history of recurrent second trimester loss(or early preterm delivery)following painless cervical dilatation in the absence of contractions, bleeding or other causes of recurrent pregnancy loss.Its treatment can be divided into expectant treatment and cervical cerclage. Many researchers support cervical cerclage and the time of surgery is during 14 and 16 weeks of gestations. But to the infertilities who are diagnosed with CIC, especially to those in whom the cervical segment is short,both doctor and patient will be easily nervous to do the procedure during this period and be anxiety of the complications such as infections and even abortions after the operation. The assisted reproductive center of Sir Run Run Shaw Hospital affiliated with Zhejiang University of Medicine has successfully reported two cases of cervical cerclage before blastocyst transfer in patients having cryopreserved embryo transfer in 2009.We choose to do the cervical cerclage before blastocyst transfer to avoid the risk of doing the operation during pregnancy. This essay updates the number of cases, analysis ten cases of performing prophylactic transvaginal cervical cerclage to those who are diagnosed of cervical incompetence and introduces the prophylactic transvaginal cervical cerclage before the preparing cycle of FET or being pregnancy and evaluates the outcome of this precedure.Eventually to provide the evidence and reference to the clinical treatment.Objective To evaluate the clinical effects of prophylactic transvaginal cervical cerclage and the treatment to patients of cervical incompetence affiliated with infertility or none pregnancy.Methods Eight patients who are suitable for IVF-ET and two patients who have repeated late inevitable abortion were identified at our assisted reproductive center of Sir Run Run Shaw hospital affiliated with Zhejiang University School of Medicine. The patients were all diagnosed of cervical insufficient and were performed prophylactic transvaginal cervical cerclage two or three months before the preparing cycle of FET or being pregnancy. The operation is the improvement of traditional surgical technique. Seven patients had single, good-quality blastocysts transferred and one patient had a Day 3 embryo transferred.Results All ten cases were successful and the postoperative were uneventful and without infection or bleeding. Eight patients got pregnancy after embryo transfer, including two patients delivered a healthy infant by cesarean section, one patient got late inevitable abortion again at 21 weeks gestation for twin pregnancy, two patients who are going on pregnancy are at 26 weeks gestation and 28 weeks gestation, three patients are on early pregnancy. Another two patients one has already got pregnancy and the other one is preparing pregnant.Conclusion It will be convenient to perform prophylactic transvaginal cervical cerclage by improving traditional suturation and both doctors and patients will be easy to accept and have a good result.Especially those in whom the distal cervical segment is short or agenesis, performing cervical cerclage during 14 weeks to 16 weeks gestation will be difficult and nervous.Single, good-quality embryo should be transferred to the patients diagnosed with cervical incompetence affiliated with infertility, which could avoid multiple pregnancy to induce late inevitable abortion again.