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Cervical incompetence treatment

Michael Barsky, Robert Kelley, Faiz Y Bhora, Anne Hardart
BACKGROUND: Pessaries are a treatment option for pelvic organ prolapse, stress urinary incontinence (SUI), and cervical incompetence. An effective pessary is comfortable, corrects the presenting problem, does not cause adverse effects, and is easy to remove. Discomfort and poor fit limit the usefulness of pessaries for many women. Each patient presents with unique anatomy and thus the effectiveness of commercially available pessaries may be limited by lack of customization. METHOD: A patient presenting with SUI and failed commercial pessary fittings desired nonsurgical treatment...
March 2018: Obstetrics and Gynecology
Jennifer Deanna, Omar Abuzied, Fahmi Islam, Ivana Vettriano, Frederico Rocha, Mostafa Abuzeid
Introduction: It is well known that cervical incompetence and associated preterm birth confers greater morbidity and mortality on birth outcomes, with an additional increased risk of cervical incompetence in higher order gestations. While the pathophysiology of cervical incompetence has yet to be elucidated, research has identified risk factors and assessed outcomes of numerous interventions. Cervical cerclage has been shown, in certain situations involving singleton pregnancies, to improve outcomes...
June 2017: Facts, Views & Vision in ObGyn
Caroline A Crowther, Pat Ashwood, Andrew J McPhee, Vicki Flenady, Thach Tran, Jodie M Dodd, Jeffrey S Robinson
BACKGROUND: Neonatal respiratory distress syndrome, as a consequence of preterm birth, is a major cause of early mortality and morbidity. The withdrawal of progesterone, either actual or functional, is thought to be an antecedent to the onset of labour. There remains limited information on clinically relevant health outcomes as to whether vaginal progesterone may be of benefit for pregnant women with a history of a previous preterm birth, who are at high risk of a recurrence. Our primary aim was to assess whether the use of vaginal progesterone pessaries in women with a history of previous spontaneous preterm birth reduced the risk and severity of respiratory distress syndrome in their infants, with secondary aims of examining the effects on other neonatal morbidities and maternal health and assessing the adverse effects of treatment...
September 2017: PLoS Medicine
Yin-Shun Zhang, Jian-Xiang Zhang, Qing-Guo Yang, Wei Li, Hui Tao, Cai-Liang Shen
BACKGROUND CONTEXT: Surgical treatment for unstable atlas fractures has evolved in recent decades from C1-C2 or C0-C2 fusion to motion-preservation techniques of open reduction and internal fixation (ORIF). However, regardless of a transoral or a posterior approach, the reduction is still not satisfactory. PURPOSE: The article describes and evaluates a new technique for treating unstable atlas fractures by using a monoaxial screw-rod system. STUDY DESIGN: This is a retrospective study...
January 2018: Spine Journal: Official Journal of the North American Spine Society
Mushi J Matjila, Anne Hoffman, Zephne M van der Spuy
BACKGROUND: In contrast to sporadic miscarriage, recurrent miscarriage (RM) is a rare entity which affects 1% of couples attempting conception. It is distressing for couples and healthcare professionals as the aetiology is unclear with limited treatment options. Apart from anti-phospholipid syndrome (APS), the strength of associations between RM and commonly investigated endocrine, autoimmune, thrombophilic and uterine structural abnormalities remains uncertain and variable. OBJECTIVES: To assess the prevalence of commonly investigated medical conditions associated with RM...
July 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
En-Lan Xia, Tin-Chiu Li, Sze-Ngar Sylvia Choi, Qiao-Yun Zhou
BACKGROUND: The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision (TCUI) in patients with unicornuate uterus. METHODS: Thirty-three patients with unicornuate uterus presented to our tertiary center for infertility or miscarriage...
February 5, 2017: Chinese Medical Journal
Shao-Wei Wang, Lin-Lin Ma, Shuai Huang, Lin Liang, Jun-Rong Zhang
BACKGROUND: Preterm birth (PTB) is the leading cause of perinatal morbidity and mortality worldwide, and its prevention is an important health-care priority. The cervical incompetence is a well-known risk factor for PTB and its incidence is about 0.1-2.0%, while there is no ideal optimum treatment recommended currently. The cervical incompetence causes about 15% of habitual abortion in 16-28 weeks. This study aimed to evaluate the effectiveness and safety of cervical cerclage and vaginal progesterone in the treatment of cervical incompetence with/without PTB history...
November 20, 2016: Chinese Medical Journal
N Sung, H J Byeon, M D Salazar Garcia, A Skariah, L Wu, S Dambaeva, K Beaman, A Gilman-Sachs, J Kwak-Kim
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...
November 2016: Journal of Reproductive Immunology
Eun-Joo Joung, Eun-Byeol Go, Jae Young Kwack, Yong Soon Kwon
A 38-year-old nulliparous woman was referred to our clinic because of cervical incompetence at 19 weeks of gestation. Trans-abdominal cervicoisthmic cerclage was performed after failure of modified Shirodkar cerclage operation in the patient at 21 weeks of gestation via a laparotomic approach. Another 38-year-old patient, who underwent loop electrosurgical excision procedure conization for treatment of cervical dysplasia 4 years ago, presented for cervical incompetence. At 18 weeks of gestation, we performed trans-abdominal laparotomic cervicoisthmic cerclage without any post-operative complications...
July 2016: Obstetrics & Gynecology Science
Xiaowu Huang, Ning Ma, Tin-Chiu Li, Yan Guo, Dongmei Song, Yuting Zhao, Enlan Xia
OBJECTIVE: To evaluate the efficacy of simplified laparoscopic cervical cerclage (SLCC) in the prevention of miscarriage and preterm delivery in women with cervical incompetence who failed to have a live birth following a vaginal cervical cerclage in a previous pregnancy. STUDY DESIGN: From Dec 2010 to January 2015, a consecutive cases of 100 subjects with cervical incompetence but who failed to have a live birth following a vaginal cervical cerclage in a previous pregnancy underwent SLCC...
June 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Haruka Nishida, Yoko Matsumoto, Kei Kawana, R James Christie, Mitsuru Naito, Beob Soo Kim, Kazuko Toh, Hyun Su Min, Yu Yi, Yu Matsumoto, Hyun Jin Kim, Kanjiro Miyata, Ayumi Taguchi, Kensuke Tomio, Aki Yamashita, Tomoko Inoue, Hiroe Nakamura, Asaha Fujimoto, Masakazu Sato, Mitsuyo Yoshida, Katsuyuki Adachi, Takahide Arimoto, Osamu Wada-Hiraike, Katsutoshi Oda, Takeshi Nagamatsu, Nobuhiro Nishiyama, Kazunori Kataoka, Yutaka Osuga, Tomoyuki Fujii
Human papillomavirus (HPV) E6 and E7 oncogenes are essential for the immortalization and maintenance of HPV-associated cancer and are ubiquitously expressed in cervical cancer lesions. Small interfering RNA (siRNA) coding for E6 and E7 oncogenes is a promising approach for precise treatment of cervical cancer, yet a delivery system is required for systemic delivery to solid tumors. Here, an actively targeted polyion complex (PIC) micelle was applied to deliver siRNAs coding for HPV E6/E7 to HPV cervical cancer cell tumors in immune-incompetent tumor-bearing mice...
June 10, 2016: Journal of Controlled Release: Official Journal of the Controlled Release Society
P L Tran, G Payet, G Barau, M Boukerrou
UNLABELLED: Cervical incompetency is one of the direct causes of neonatal morbidity and mortality; a unique and efficient treatment of which is cervical cerclage. The objective of this study was the evaluation of physicians' practice patterns concerning cerclage in Reunion Island, in order to reinforce the management and information of patients at risk. The indications and complications of cerclages effectuated in 2010 and 2011 were compared to the literature. MATERIAL AND METHODS: In this retrospective study, all the medical records of cerclage realized in Reunion Island during two years were collected and analyzed, specifically data concerning patients' cerclage, the complications, and the outcome of the pregnancy...
September 2016: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
M Doret
OBJECTIVES: To propose guidelines for clinical practice for routine postnatal visit and after pathological pregnancies. MATERIALS AND METHODS: Bibliographic searches were performed with PubMed and Cochrane databases, and within international guidelines references. RESULTS: Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, when after normal pregnancy and delivery (Professional consensus)...
December 2015: Journal de Gynécologie, Obstétrique et Biologie de la Reproduction
Rajiv Chadha, Niyaz Ahmed Khan, Shalu Shah, Nitin Pant, Amit Gupta, Subhasis Roy Choudhury, Pinaki Ranjan Debnath, Archana Puri
AIMS: To discuss the assessment and management of genitourinary (GU) tract abnormalities in 21 girls with Types I-III congenital pouch colon (CPC), studied over a period of 10 years. MATERIALS AND METHODS: Assessment included clinical and radiological assessment, examination under anesthesia (EUA), endoscopy of the lower GU tract, and evaluation of the surgical findings, operative procedures for the GU anomalies, and the results of management. RESULTS: Initial examination of the external genitalia showed a "clover-leaf" appearance (n = 6) and a single perineal opening (n = 6)...
July 2015: Journal of Indian Association of Pediatric Surgeons
Shinichi Ishioka, Toshiaki Endo, Tsuyoshi Baba, Yushi Akashi, Miyuki Morishita, Asuka Sugio, Naohiro Kanayama, Tsuyoshi Saito
Pregnancy after radical trachelectomy (RT) has a high risk of prematurity and complications such as preterm premature rupture of the membrane and chorioamnionitis. Placing a cervical cerclage at the time of RT plays an important role in preventing such obstetrical complications. In patients who have trouble with the cervical cerclage, miscarriage during the second trimester seems to be inevitable. We have therefore started preconception transabdominal cerclage (TAC) for these patients. A 36-year-old Japanese woman who had a history of miscarriage due to trouble with the nylon thread used for cerclage, successfully delivered after TAC...
August 2015: Journal of Obstetrics and Gynaecology Research
Leonarda Ciancimino, Antonio Simone Laganà, Giovanna Imbesi, Benito Chiofalo, Alfredo Mancuso, Onofrio Triolo
BACKGROUND: Several techniques of emergency vaginal cerclage have been proposed in case of unexpected and abrupt cervical incompetence (CI), in order to prolong the pregnancy as much as possible and to reduce the adverse maternal-fetal outcomes. The aim of our study was to evaluate the effectiveness of emergency cervical cerclage, performed with the combined modified Shirodkar-McDonald technique. METHODS: We selected 12 cases of emergency vaginal cerclage, performed between January 1, 2008 and June 30, 2013...
May 2015: Journal of Clinical Medicine Research
Norbert Winer, Florence Bretelle, Marie-Victoire Senat, Caroline Bohec, Philippe Deruelle, Frank Perrotin, Laure Connan, Christophe Vayssière, Bruno Langer, Marianne Capelle, Shohreh Azimi, Raphael Porcher, Patrick Rozenberg
OBJECTIVE: The objective of the study was to evaluate the efficacy of 17 alpha-hydroxyprogesterone caproate (17OHP-C) in prolonging gestation in patients with a short cervix and other risk factors for preterm delivery, such as previous preterm birth, cervical surgery, uterine anomalies, or prenatal diethylstilbestrol (DES) exposure. STUDY DESIGN: This open-label, multicenter, randomized controlled trial included asymptomatic singleton pregnancies from 20(+0) through 31(+6) weeks of gestation with a cervical length less than 25 mm and a history of preterm delivery or cervical surgery or uterine malformation or prenatal DES exposure...
April 2015: American Journal of Obstetrics and Gynecology
Fidan Israfil-Bayli, Philip Toozs-Hobson, Christoph Lees, Mark Slack, Khaled Ismail
BACKGROUND: Cervical incompetence is one of the causes of preterm birth and mid-trimester pregnancy loss. Cervical cerclage is a surgical procedure to treat cervical incompetence. Cervical cerclage reduces the incidence of preterm birth in women at risk of recurrent preterm birth, without a statistically significant reduction in perinatal mortality or neonatal morbidity. Multifilament/braided sutures such as Mersilene tape have been traditionally used for cervical cerclage. Braided sutures, particularly mesh-like non-absorbable sutures, have been associated with an increased risk of infection and, hence, some obstetricians prefer to use monofilament/non-braided sutures...
October 27, 2014: Trials
Hua Zhou, Liang Jiang, Feng Wei, Miao Yu, Fengliang Wu, Xiaoguang Liu, Zhongjun Liu, Gengting Dang
BACKGROUND: Chordomas of the upper cervical spine are rare and present unique surgical challenge. This study aimed to describe the clinical characteristics and surgical management of patients with chordomas of the upper cervical spine. METHODS: Twenty-one patients with chordomas of the upper cervical spine who were treated in Peking University Third Hospital from January 1999 to October 2012 were retrospectively analyzed. Survival was calculated by the Kaplan-Meier method and was compared between groups using the log-rank test...
2014: Chinese Medical Journal
R A Schubert, E Schleussner, J Hoffmann, A Fiedler, H Stepan, A Gottschlich
In spite of the continuous progress in prenatal care, 1 out of 10 babies is born too early--tendency rising worldwide. As a consequence of the heterogeneous aetiology of preterm birth, there is still no single and efficient interventional therapy. Cerclage is one option for pregnancies with cervical insufficiency, whereas the clinical benefit is discussed controversially. We analyzed in a retrospective study with 120 patients the effect of a cerclage intervention regarding pregnancy prolongation. Patients with cervical incompetence and Shirodkar cerclage were compared to those undergoing conservative treatment...
August 2014: Zeitschrift Für Geburtshilfe und Neonatologie
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