22 May 2023 : Case report
[In Press] Case Report of a 31-Year-Old Woman with COVID-19 and Chorioamnionitis at 18 Weeks of Gestation with a Twin Pregnancy and an Abdominal Cerclage for Cervical Incompetence Removed by Posterior Colpotomy Approach
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatmentDaisy A. Khaled Massoud1ABCDEF, Jean Nassar1ABC, Joe Khalifeh1ABC, Jacqueline C. Saad1ABC, Stephanie F. Yacoub1ABCEF, Joseph Ghanem1ABCD, Rouphael Sfeir2ABCE, Elie Nicolas Anastasiadis1ABCDE
Am J Case Rep In Press; DOI: 10.12659/AJCR.938824
Available online: 2023-05-22, In Press, Corrected Proof
Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule
Cervical incompetence and cervical anatomical deformities are the major causes of mid-trimester pregnancy losses and preterm birth. Cervical cerclages are done to prevent such complications from occurring. Abdominal cerclages are done in patients with a history of failed vaginal cerclage or a history of severe cervical deformities that make vaginal placement technically difficult. Abdominal cerclages have the benefit of being placed at a higher level at the internal cervical os, and can be kept for future pregnancies. Abdominal cerclages are preferably done in a minimally invasive approach, and interval cerclages are preferred to conceptional cerclage owing to the technical challenge posed by the gravid uterus. In some cases, abdominal cerclage removal is needed because of pregnancy complications, such as fetal demise and chorioamnionitis. Different removal approaches have been described, such as the traditional transabdominal approach and laparoscopic and vaginal approaches with a colpotomy.
Colpotomy is the least invasive technique and avoids higher morbidity rates associated with laparotomy and laparoscopy.
We present a case report of a twin pregnancy complicated by chorioamnionitis and COVID-19 disease that necessitated the removal of an abdominal cerclage by a posterior colpotomy approach, which was the most adapted approach given the risk factors of the patient in question.
In performing a posterior colpotomy approach for the removal of an abdominal cerclage, major complications of general anesthesia and the operative risks of a laparoscopy/laparotomy were avoided in a patient with major risk factors, and better operative conditions were attained.
Keywords: Cerclage, Cervical; Colpotomy; Twins; Chorioamnionitis; Coronavirus
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