Technically Difficult Laparoscopic Abdominal Cerclage in a Patient With Bicornuate Uterus

Devika Gunasheela, Ashwini Nagaraj, Lohith Chengappa Appaneravanda, Rajsekhar Nayak, Vasanth Kumar Kariyappa

Abstract

The incidence of uterine anomalies is 2% to 8% in subfertile women and 5% to 30% in women with miscarriages. A bicornuate uterus results from unification defect during the fetal stage itself and is shown to adversely affect reproductive outcomes. Although women with a bicornuate uterus may have successful pregnancy outcomes, they are still prone to obstetric complications. It has previously been established that transabdominal cervical cerclage (TAC) in the interconception period has been shown to be safe and effective to improve pregnancy outcomes. In this case study, we intend to showcase a successful live birth after the placement of a technically challenging laparoscopic TAC.

A 28-year-old woman with a history of secondary infertility with a bicornuate uterus presented to Gunasheela Surgical and Maternity Hospital (Bengaluru, Karnataka, India). She had multiple spontaneous miscarriages in spite of a previous cervical stitch. Hence, TAC was planned in the interconception period. During TAC, a band of peritoneal adhesion was noted between the bladder anteriorly and the rectum posteriorly, dividing the uterus into 2 horns. The same was resected, and a mersilene tape was passed at the level of the common cervix medial to the uterine vascular pedicles, with a knot being tied posteriorly. The patient was then discharged with regular follow-up reviews. She conceived naturally after her next menstrual cycle. Meticulous antenatal visits were planned to prevent any obstetric complications. A female neonate was delivered through elective lower segment cesarean delivery after 37 weeks. There were no intraoperative complications from the TAC.

Laparoscopic TAC technique appears to be safe and effective in preventing repeated midtrimester pregnancy losses.