I recently had a case of a couple with three previous failed IVF cycles and one mid-trimester abortion. Mrs.S, conceived twins in her fourth IVF attempt with donor oocytes at our centre.
Despite having a cervical stitch (McDonald’s suture) in her last pregnancy, she had a mid-trimester abortion in 2012. For her current twin pregnancy, I recommended that she try Transabdominal cerclage procedure to prevent a repeat abortion, especially after her multiple IVF attempts.
Laparoscopic abdominal cerclage is a viable option for women with bad obstetric histories such as recurrent pregnancy loss or with conditions like short /absent cervix.
While a traditional cervical stitch is put transvaginally, abdominal cerclage is performed higher up, close to the internal OS. The advantages are :
- Abdominal cerclage is more secure than a cervical stitch, especially later in pregnancy and for twins/triplets.
- It minimizes the risk of vaginal infections.
- Since the cerclage is done abdominally, the patient can contemplate future pregnancies.
I performed the abdominal cerclage procedure with my colleague, Dr. Anil Magdum, who had flown down from Mumbai, especially for this. After the procedure, Mrs.S. was advised complete bed rest along with other supportive medication. She delivered her twins pre-term by ceasarean section at 36 -2 weeks and her babies were in the NICU for ten days. My entire team at Lalbagh Nursing Home and Mrs.S. and her family were elated at the outcome.
Following this case, we had another patient, Mrs.M., with three previous abortions and cervical stitch put in the last pregnancy. Mrs.M. however, decided to get the Abdominal cerclage procedure done in the United States. After the procedure, I delivered her baby by ceasarean section at 37 + weeks at Lalbagh Nursing Home.
We were able to perform the Laparoscopic abdominal cerclage for our first patient, Mrs.S. at 1/5th the cost of what it does in the United States with a favourable outcome. Not to mention the visa process, long travel and stay involved.