Uterine Evacuation in the Setting of Transabdominal Cerclage

INTRODUCTION: Cervical insufficiency is associated with preterm delivery and recurrent pregnancy loss. Transabdominal cerclage, a more effective treatment alternative to transvaginal cerclage with >90% efficacy in preventing preterm delivery, is also permanent and requires delivery by cesarean. Patients with a transabdominal cerclage may require uterine evacuation via dilation and curettage (D In addition to laminaria, two received mifepristone, and one received misoprostol and mifepristone. Mean preoperative cervical dilation achieved was 1 cm (range 0.5–1.5 cm). Four patients required additional intraoperative dilation, up to 59 French. Mean EBL was 230 cc (range 50–600 cc), and mean operative time was 45 minutes (range 16–92). Both 20-week procedures were prolonged by challenging cervical dilation (80 and 92 minutes). One 20-week D&E had two complications: a superficial posterior cervical laceration and delayed retained products requiring hysteroscopic removal. CONCLUSIONS: We describe D&C and D&E techniques and outcomes in patients with transabdominal cerclage. Our findings support the safety and feasibility of utilizing standard practices for cervical preparation with transabdominal cerclage in place, which can reassure clinicians and patients. Compared with more invasive alternatives such as hysterotomy or cerclage removal, D&C and D&E with experienced surgeons offer a feasible, lower morbidity alternative. However, the prolonged operative time and complications described in both 20-week D&Es highlight the need for more data at more advanced gestations.Table 1