Operations for cervical incompetence

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Introduction:

  • Cervical incompetence is the MC acquired uterine anomaly
  • Definition: Cervical length in 2nd trimester <2.5 cm
  • History: Recurrent pregnancy loss at 2nd trimester
  • There is painless cervical dilatation.

Operations in pregnant women: Cervical cerclage:

  • It is a surgical procedure in which sutures or synthetic tape is used to reinforce the cervix
  • The purpose of cervical cerclage is to increase the mechanical strength of the cervix, thereby preventing painless passive dilatation and premature delivery
  • Ideal time to put cerclage: 12-14 weeks
  • Ideal time of stitch removal: 37 weeks
  • It is of 2 types:
  1. McDonald operation:
    • MC-ly performed
    • Repeated purse string sutures are placed around the cervix at the level of the internal os.
  2. Shirodkar operation:
    • Technically difficult
    • Less commonly performed
    • The sutures pass through the walls of cervix so they’re not exposed.

Operation in non-pregnant women: Lash and Lash operation:

  • Patients with habitual second-trimester abortions occasionally show a defect in the wall of cervix, which results in a weakened internal cervical os
  • In Lash and Lash operation, the defect is located, excised and then closed to restore competence to the cervix

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