Local injection of diluted vasopressin at the time of the modified Shirodkar cerclage

Abstract

Objective: To report surgical outcomes of the modified Shirodkar method performed using diluted vasopressin.Case presentations: The age range of patients who underwent hydrodissection was 24-39 years (Mean age 30.9 years). Out of the 10 cases, four (40%) of them had failed McDonald cerclage in previous pregnancies, four (40%) of them had emergency cerclage, one (10%) of them had previous second trimester (T2) miscarriage/miscarriages and short cervix on USS and one (10%) had short cervix on ultrasound alone as indications. Four (40%) of them had the stitch performed after 20 weeks of gestation and six (60%) had it done before 20 weeks.During the procedure no single case of adverse cardiac events or raised blood pressure was noted. Estimated blood loss (EBL) ranged from 5 to 10 ml (mean EBL - 6.5 ml). Four (40%) procedures were recorded as difficult procedures by the operator. Not a single case of tonic uterine contractions was recorded following the procedure. One (10%) of them had a vaginal delivery at term, one (10%) had a vaginal delivery at 26 weeks, four had CS (40%) at term, and four (40%) of them delivered vaginally between 34-37 weeks. Only one (10%) case had a retained piece of stitch in the cervix and in one (10%) the stitch was left in-situ as requested by the patient. Only one (10%) patient had delivered at 26 weeks, eight of them (80%) had continued their pregnancies beyond 34 weeks.Conclusion: Our experience shows that judicious use of local injection of diluted vasopressin to perform hydrodissection during the modified Shirodkar cerclage is a safe and efficacious method and would increase the overall quality of the technique by reducing the blood loss and enhancing the plane of dissection.