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relating to or associated with the neck
of or relating to the cervix of the uterus; "cervical cancer"

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2012/09/21 18:57:00」(JST)

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Cervical cerclage (tracheloplasty), also known as a cervical stitch, is used for the treatment of cervical incompetence (or insufficiency), ^[1] a condition where the cervix has become slightly open and there is a risk of miscarriage because it may not remain closed throughout pregnancy. Usually this treatment would be done, in the second trimester of pregnancy, for a woman who had either suffered from one or more miscarriages in the past, or is carrying multiples.

The treatment consists of a strong suture being inserted into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed.

Types

There are three types of cerclage:^[2]

A McDonald cerclage, described in 1957 is the most common, and is essentially a pursestring stitch used to cinch the cervix shut; the cervix stitching involves a band of suture at the upper part of the cervix while the lower part has already started to efface. This cerclage is usually placed between 12 weeks and 14 weeks of pregnancy. The stitch is generally removed around the 37th week of gestation. ^[3]
A Shirodkar cerclage is very similar, but the sutures pass through the walls of the cervix so they're not exposed. This type of cerclage is less common and technically more difficult than a McDonald, and is thought (though not proven) to reduce the risk of infection. The Shirodkar procedure sometimes involves a permanent stitch around the cervix which will not be removed and therefore a Caesarean section will be necessary to deliver the baby. The Shirodkar technique was first described by Dr. V. N. Shirodkar in Bombay in 1955. In 1963, Dr. Shirodkar traveled to NYC to perform the procedure at the New York Hospital of Special Surgery; the procedure was successful, and the baby lived to adulthood.^{[citation needed]}
An abdominal cerclage, the least common type, is permanent and involves stitching at the very top of the cervix, inside the abdomen. This is usually only done if the cervix is too short to attempt a standard cerclage, or if a vaginal cerclage has failed or is not possible. However, a few doctors (namely Dr. Arthur Haney at the University of Chicago and Dr. George Davis at the University of Medicine and Dentistry of New Jersey) are pushing for the transabdominal cerclage to replace vaginal cerclages, due to perceived better outcomes and more pregnancies carried to term.^{[citation needed]}

Aftercare

After the cerclage has been placed, the patient will be observed for at least several hours (sometimes overnight) to ensure that she does not go into premature labor. The patient will then be allowed to return home, but will be instructed to remain in bed or avoid physical activity for two to three days, or up to two weeks. Follow-up appointments will usually take place so that her doctor can monitor the cervix and stitch and watch for signs of premature labor.

Risks

While cerclage is generally a safe procedure, there are a number of potential complications that may arise during or after surgery. These include:

risks associated with regional or general anesthesia
premature labor
premature rupture of membranes
infection of the cervix
infection of the amniotic sac (chorioamnionitis)
cervical rupture (may occur if the stitch is not removed before onset of labor)
injury to the cervix or bladder
bleeding
Cervical Dystocia with failure to dilate requiring Cesarean Section
displacement of the cervix

Normal results

The success rate for cervical cerclage is approximately 80-90% for elective cerclages, and 40-60% for emergent cerclages. A cerclage is considered successful if labor and delivery is delayed to at least 37 weeks (full term).^[4]

Morbidity and mortality rates

Approximately 1-9% of women will experience premature labor after cerclage. The risk of chorioamnionitis is 1-7%, but increases to 30% if the cervix is dilated greater than 1.2 in (3 cm). The risks associated with premature delivery, however, are far greater. Babies born between 22 and 25 weeks of pregnancy are at significant risk of moderate to severe disabilities (46-56%) or death (approximately 10-30% survive at 22 weeks, increasing to 50% at 24 weeks, and 95% by 26 weeks).^{[citation needed]}

References

^ Fox NS, Chervenak FA (January 2008). "Cervical cerclage: a review of the evidence". Obstet Gynecol Surv 63 (1): 58–65. doi:10.1097/OGX.0b013e31815eb368. PMID 18081941. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0029-7828&volume=63&issue=1&spage=58.
^ Paula JAdams Hillard; Paula Adams Hillard (1 May 2008). Five-minute obstetrics and gynecology consult. Lippincott Williams & Wilkins. pp. 482–. ISBN 978-0-7817-6942-6. http://books.google.com/books?id=fOoFIQOdIhkC&pg=PA482. Retrieved 5 November 2010.
^ http://www.americanpregnancy.org/pregnancycomplications/cervicalcerclage.html
^ About.com. Pregnancy & Childbirth: The Incompetent Cervix - Cerclage, Bedrest and Other Treatments

External links

Drakeley AJ, Roberts D, Alfirevic Z. "Cervical stitch (cerclage) for preventing pregnancy loss in women". The Cochrane Collaboration, Cochrane Reviews. http://www.cochrane.org/reviews/en/ab003253.html. Retrieved 2007-11-06.

UpToDate Contents

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1. 経膣的子宮頸管縫縮術 transvaginal cervical cerclage
2. 頸管無力症 cervical insufficiency
3. 経腹壁子宮頸管縫縮術 transabdominal cervical cerclage
4. 自然早産予測のための、妊娠中期の子宮頸部長測定 second trimester evaluation of cervical length for prediction of spontaneous preterm birth
5. 子宮頸癌に対する妊孕性温存手術 fertility sparing surgery for cervical cancer

English Journal

Reinforcing cerclage for a short cervix at follow-up after the primary cerclage procedure.

Contag SA1, Woo J2, Schwartz DB1, Arrabal PP2, O'Reilly G2, Harper M3.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Aug;29(15):2422-7. doi: 10.3109/14767058.2015.1086740. Epub 2015 Oct 1.
OBJECTIVE: To determine whether a reinforcing cerclage (RC) for a short cervix measured after the primary cerclage procedure prolonged pregnancy.METHODS: We conducted a retrospective cohort study of 157 women with singleton gestations who underwent cerclage for standard indications. Women were group
PMID 26429503

Infant outcomes following midtrimester emergency cerclage in the presence of fully dilated cervix and prolapsing amniotic membranes into the vagina.

Ozgur Akkurt M1, Yavuz A1, Sezik M1, Okan Ozkaya M1.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.J Matern Fetal Neonatal Med.2016 Aug;29(15):2437-41. doi: 10.3109/14767058.2015.1087495. Epub 2015 Sep 28.
OBJECTIVE: To investigate the morbidity of infants, whose delivery was prolonged by an emergency cervical cerclage (EC).METHODS: Ante- and postnatal data on subsequent EC procedures performed between 14 and 28 weeks of gestation for advanced cervical dilatation with prolapsing of amniotic membranes
PMID 26414335

Cerclage in twin pregnancy with dilated cervix between 16 to 24 weeks of gestation: retrospective cohort study.

Roman A1, Rochelson B2, Martinelli P3, Saccone G3, Harris K2, Zork N4, Spiel M5, O'Brien K5, Calluzzo I6, Palomares K7, Rosen T7, Berghella V8, Fleischer A2.
American journal of obstetrics and gynecology.Am J Obstet Gynecol.2016 Jul;215(1):98.e1-98.e11. doi: 10.1016/j.ajog.2016.01.172. Epub 2016 Jan 28.
BACKGROUND: Cervical dilation in the second trimester is associated with a greater than 90% rate of spontaneous preterm birth and a poor perinatal prognosis.OBJECTIVE: To compare the perinatal outcomes of twin pregnancies with dilated cervix in women who underwent either cerclage or expectant manage
PMID 26827881

Japanese Journal

IS-48 A Significance of emergency total cervical occlusion (double cerclage) in advanced cervical incompetence(Group7 Perinatology1,International Session)