Difference between revisions of "Cerclage placement"
From WikiAnesthesia
(Created page with "{{Infobox surgical procedure | anesthesia_type = | airway = | lines_access = | monitors = | considerations_preoperative = | considerations_intraoperative = | considerations_postoperative = }} Cervical cerclage placement is a procedure where the cervix is sewn closed with stitches to prevent premature labor. == Overview == === Indications<!-- List and/or describe the indications for this surgical procedure. --> === === Surgical procedure<!-- Briefly describe th...") |
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== Overview == | == Overview == | ||
=== Indications<!-- | === Indications<!-- A cervical cerclage is a procedure used to prevent preterm birth in women at risk of cervical insufficiency, ultimately to prevent potential miscarriage. | ||
The primary indications for cerclage placement include a history of spontaneous preterm birth, a previous cerclage procedure, and diagnosed cervical insufficiency, often characterized by a cervical length of less than 25mm in the second trimester as measured via transvaginal ultrasound. Women with a history of multiple second-trimester losses or preterm deliveries related to cervical dilation may also benefit from cerclage. Additional indications include the presence of painless cervical shortening in the absence of contractions or membrane rupture, and in certain cases, cerclage may be considered for those with abnormal cervical findings discovered on ultrasound screening in asymptomatic women at high risk. --><ref>Klemm, P., Vayssière, C., & Marret, H. (2020). ''Cervical cerclage in prevention of preterm birth: A critical review of indications and efficacy''. European Journal of Obstetrics & Gynecology and Reproductive Biology, 249, 31-37.</ref><ref>Lyndon, A., Smith, R. S., & McIntire, D. D. (2021). ''Cervical cerclage: Indications, techniques, and outcomes''. American Journal of Obstetrics and Gynecology, 224(4), 455-463.</ref> === | |||
=== Surgical procedure<!-- | === Surgical procedure<!-- The procedure involves multiple key steps: | ||
Preparation and Positioning: The patient is positioned in a lithotomy position, similar to that for a pelvic examination. After ensuring sterile technique, a speculum is inserted into the vagina to expose the cervix. | |||
Cervical Examination: The cervix is evaluated for abnormalities, such as shortening, dilation, or funneling. If no signs of infection or active labor are present, the decision to proceed with the cerclage is confirmed. | |||
Placement of the Cerclage: A purse-string suture (usually made of a non-absorbable material) is placed around the cervix. The suture is typically inserted at the level of the internal os, ensuring it is snug but being careful to avoid damage to the cervical tissue. The suture is then tied, effectively "closing" the cervix to prevent early dilation. | |||
Confirmation and Closure: The cervix is re-examined to ensure the suture is correctly placed. After confirming that the suture is secure, the speculum is removed, and the patient is monitored for complications, like bleeding. | |||
Post-Procedure Care: The patient is usually monitored for a short period following the procedure, and they are advised to avoid heavy physical activity for several weeks post-cerclage. --><ref>Coomarasamy, A., Small, R., & Cacciatore, S. (2017). ''Cervical cerclage for preventing preterm birth in women with a short cervix''. Cochrane Database of Systematic Reviews, 2017(7)</ref><ref>Klemm, P., Vayssière, C., & Marret, H. (2020). ''Cervical cerclage in prevention of preterm birth: A critical review of indications and efficacy''. European Journal of Obstetrics & Gynecology and Reproductive Biology, 249, 31-37.</ref> === | |||
== Preoperative management == | == Preoperative management == | ||
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|- | |- | ||
|Airway | |Airway | ||
| | |Evaluate for Mallampati score, upper Bite Lip test, checking for lose or chipped dentition and overall keeping in mind that the airway tends to be edematous and friable in gravid patients. | ||
|- | |- | ||
|Neurologic | |Neurologic | ||
| | |Complete a standard neurological exam, asking detailed questions about chronicity of lower back pain, any history of sciatica, spine surgery, and/or extremity weakness, numbness or tingling. | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
| | |Obtain a brief history of the patients cardiovascular tolerance before and during pregnancy and auscultate to rule out murmurs. | ||
|- | |- | ||
|Pulmonary | |Pulmonary | ||
| | |Obtain a detailed history on pulmonary diseases such as asthma, recent URI, or cough. No other special considerations beyond being aware of the standard pulmonary changes that occur in pregnancy. | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| | |Confirm if the patient is on medication for GERD and verify NPO status. | ||
|- | |- | ||
|Hematologic | |Hematologic | ||
| | |Obtain a brief history on any history coagulopathy since neuraxial is a consideration for this procedure. | ||
|- | |- | ||
|Other | |Other | ||
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=== Labs and studies<!-- | === Labs and studies<!-- Cervical cerclage placement is typically performed in a sterile surgical setting, often under regional anesthesia (such as a spinal or epidural block), though general anesthesia may be used in certain cases. Important studies required prior to cerclage placement include a BMP, CBC, PT, PTT/INR. Other necessary information would be to confirm if the patient has been given any medication for DVT prophylaxis and if so, what the dose was and how long ago it was given. -->=== | ||
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | === Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> === | ||
Revision as of 15:49, 8 January 2025
Cerclage placement
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| Airway | |
| Lines and access | |
| Monitors | |
| Primary anesthetic considerations | |
| Preoperative | |
| Intraoperative | |
| Postoperative | |
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| User likes | 0 |
Cervical cerclage placement is a procedure where the cervix is sewn closed with stitches to prevent premature labor.
Overview
Indications[1][2]
Surgical procedure[3][4]
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | Evaluate for Mallampati score, upper Bite Lip test, checking for lose or chipped dentition and overall keeping in mind that the airway tends to be edematous and friable in gravid patients. |
| Neurologic | Complete a standard neurological exam, asking detailed questions about chronicity of lower back pain, any history of sciatica, spine surgery, and/or extremity weakness, numbness or tingling. |
| Cardiovascular | Obtain a brief history of the patients cardiovascular tolerance before and during pregnancy and auscultate to rule out murmurs. |
| Pulmonary | Obtain a detailed history on pulmonary diseases such as asthma, recent URI, or cough. No other special considerations beyond being aware of the standard pulmonary changes that occur in pregnancy. |
| Gastrointestinal | Confirm if the patient is on medication for GERD and verify NPO status. |
| Hematologic | Obtain a brief history on any history coagulopathy since neuraxial is a consideration for this procedure. |
| Other |
Labs and studies
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ Klemm, P., Vayssière, C., & Marret, H. (2020). Cervical cerclage in prevention of preterm birth: A critical review of indications and efficacy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 249, 31-37.
- ↑ Lyndon, A., Smith, R. S., & McIntire, D. D. (2021). Cervical cerclage: Indications, techniques, and outcomes. American Journal of Obstetrics and Gynecology, 224(4), 455-463.
- ↑ Coomarasamy, A., Small, R., & Cacciatore, S. (2017). Cervical cerclage for preventing preterm birth in women with a short cervix. Cochrane Database of Systematic Reviews, 2017(7)
- ↑ Klemm, P., Vayssière, C., & Marret, H. (2020). Cervical cerclage in prevention of preterm birth: A critical review of indications and efficacy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 249, 31-37.