![]() Other physical examination findings were normal. Vaginal examination revealed a loose cervical cerclage tape and protruding unruptured amniotic sac membranes. One day after discharge, patient returned back to our hospital for readmission with complaint of lower abdominal pain which started 2 hours prior to presentation. On the day of discharge, she had no complaints, her physical examination, fetal assessment and ultrasound findings were normal with closed cervical os and cervical length as shown in Figure 4. Patient was advised to stay longer in the hospital but declined. Patient was discharged from the hospital 15 days after the procedure at 25weeks 1day gestation age. The Shirodkar procedure was successfully performed without any complications after reducing the amniotic sac membranes back into the uterus ( Figure 3).įigure 3 Showing the reduced membranes back into the uterus and sutured cervix.īlue arrow-sutured cerclage tape, white arrow-ectocervix, black arrow-closed cervical external os. Plan of emergency transvaginal cerclage placement, tocolysis/fetal protection with magnesium sulphate, oral progesterone, IV fluids for hydration, antibiotics for infection prevention and patient counselling was initiated within 1 hour after admission. An impression of inevitable abortion secondary to cervical insufficiency was made. On physical examination, significant findings were noted on vaginal and speculum examination with open cervix of 5cm and unruptured membranes bulging through the cervical os ( Figure 2). Married, other history was not significant for any risk of cervical incompetence. ![]() Patient also denied any history of fever, headache, dizziness, cough or diarrhea. She denied any history of vaginal bleeding, vaginal draining or discharge. ( Figure 1) She presented to our hospital with complaint of lower abdominal pain which started 5 hours prior to presentation. Case presentationĬhinese female 33 years old, G1P0, 23weeks 6days gestation age by scan, referred from a local hospital due to cervical insufficiency with cervical length of 0.309cm discovered during routine antenatal visit. 5–8 High index of suspicion, early and accurate diagnosis of cervical insufficiency is critical so that necessary interventions of cervical cerclage placement is done to prolong gestation age, prevent preterm labor, neonatal morbidity and mortality. 4Treatment of cervical insufficiency is done by cerclage placement either by laparoscopic or transvaginal approach to prolong pregnancy, prevent preterm birth and avoid poor neonatal outcomes. 3 Some causes of cervical insufficiency include previous trauma to the cervix (conization procedures, lacerations during delivery, catheter mechanical dilatation during induction of labor) and congenital anomalies (Marfan syndrome, Ernlos-Danlos syndrome, exposure to diethylstilbestrol, cervical malformations). It is one of the causes of preterm birth that lead to 35% of neonatal mortality. 1, 2 Cervical insufficiency is the painless spontaneous dilatation of the cervix without uterine contractions. 1% of all pregnancies and 8% of recurrent miscarriages are associated with cervical insufficiency.
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