Obstetrics and Gynecology - A.M. Gromova 2000

Operative Obstetrics
Pregnancy-Preserving Procedures

One of the primary causes of Pregnancy loss is cervical incompetence. In this condition, the gestational sac lacks adequate support in the lower uterine segment due to anatomical or functional insufficiency of the cervix and isthmus. During pregnancy, the cervix in such patients shortens, and both the external and internal os dilate. The fetal membranes bulge into the cervical canal, become infected, and rupture, leading to premature termination of pregnancy. Surgical intervention is used during pregnancy to prevent this.

The Shirodkar method involves placing a cervical cerclage around the cervix at the level of the internal os, following prior incision of the vaginal mucosa and upward Displacement of the Urinary Bladder.

The McDonald method: narrowing of the internal os is achieved by placing a purse-string suture in the vaginal fornices without incising the mucosa. Chromic catgut or silk is used for this purpose.

A.N. Lyubimova's method consists of placing a circular suture made of copper wire with a polyethylene sheath around the internal os of the cervix and securing it with interrupted sutures in the vaginal fornices.

The Szendi method involves complete closure of the external os of the cervix. First, a thin (0,5 cm) strip of the cervical canal mucosa around the external os is excised, and interrupted catgut or silk sutures are applied. After healing, a scar forms, which is incised with the blade of a sponge forceps or a scalpel prior to delivery.

Management of the postoperative period:

— bed rest for 5-7 days;

— postoperative administration of partusisten (0,5 mg per 500 ml of isotonic sodium chloride solution) is indicated to reduce uterine contractility;

— to achieve normal uterine tone, 30 minutes before discontinuing intravenous partusisten, transition to oral administration of this drug is indicated;

— vaginal irrigation with hydrogen peroxide or furatsilin solution for 5-7 days;

— limit vaginal examinations or speculum inspections of the cervix unless absolutely necessary for 2-3 weeks;

— 2 weeks before the expected due date, the woman must be hospitalized for suture removal. Control questions:

Classification of obstetric operations.

Name the operations that preserve pregnancy.

Name the Basic principles of the Methods used for cervical incompetence.

How should the postoperative period be managed after cerclage placement on the cervix?