Cerclage Related Complications after Trachelectomy: A Retrospective Case Series

Abstract

Results: Ten patients suffered from cerclage related complications after trachelectomy. The cerclage position was examined by transvaginal ultrasound. Cerclages were displaced after (i) trachelectomy (n=6), (ii) cesarean section following trachelectomy (n=2) and (iii) trachelectomy and cesarean section, complicated by a uterine niche (n=2). Five patients were pregnant at diagnosis of cerclage displacement: four patients presented with preterm prelabor rupture of the membranes (PPROM) in the second trimester and one patient underwent trachelectomy in the late first trimester, complicated by an intrauterine infection and cerclage migration to the vagina. All five pregnancies were terminated because of intrauterine infection and/or poor fetal prognosis after removal of the dislocated cerclage. Cerclages were removed vaginally (n=7), hysteroscopically (n=2) or laparoscopically (n=1). Five patients were not pregnant at diagnosis of cerclage displacement: three patients presented with gynecological symptoms and two patients presented with subfertility with the cerclage located in the uterine niche.