Laparoscopic Cerclage for Twins at 11 Weeks Gestation
Christopher J. Kliethermes, MD, Karin A. Fox, MD, Kelly K. Blazek, MD, Shadi Rezai, MD, Zhenkun Guan, BS, Xiaoming Guan, MD, PhD
Division of Minimally Invasive Gynecologic Surgery (Drs Kliethermes, Blazek, Rezai, and Dr Guan) and Division of Maternal Fetal Medicine (Dr Fox), Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA. Guangzhou Medical University, Guangzhou Shi, China (Mr Guan, Dr Guan).
Introduction: Preterm labor and cervical insufficiency are significant health problems in obstetrics. They can lead to devastating outcomes for families and significant costs. Cervical and abdominal cerclages can improve outcomes in appropriately selected patients.
Case Report: This is a case of a 31-year-old woman (Gravida 8, Para 1-2-4-1) who presented at 11 weeks with a diamniotic–dichorionic twin gestation. A laparoscopic abdominal cerclage was placed and she successfully carried her pregnancy to 35 weeks, when she was delivered for obstetric indications.
Discussion: Despite convincing literature suggesting increased morbidity with cerclage placement in twin gestations, in properly selected patients, a cerclage may in fact be beneficial. Growing evidence has shown effectiveness of laparo- scopically placed cerclages, and should be considered an alternative to laparotomy. Laparoscopic abdominal cerclage can safely be performed for twin gestation. Multispecialty approach can improve outcomes and increase safety. Gentle tissue handling is important in all laparoscopic surgery, but especially during pregnancy.
Key Words: Abdominal cerclage, Laparoscopic cerclage, Twin pregnancy.