Rescue Vaginal Cerclage to Stop Funneling Following Laparoscopic Cerclage - Revista Brasileira de Ginecologia e Obstetrícia

Dear Editor,

Laparoscopic cerclage is an effective treatment option for cervical insufficiency leading to repeated preterm birth. However, surgical intervention with various cerclage techniques, such as vaginal, transabdominal laparoscopic approaches, still remains the ultimate solution, unfortunately, without the guarantee of success. There is still no consensus regarding the priority of each technique over the other. However, when laparoscopic cerclage fails to completely treat cervical insufficiency, an additional vaginal cerclage should be considered as a rescue intervention. We suggest considering Shirodkar vaginal cerclage a rescue technique following laparoscopic transabdominal cerclage which is compromised by further funneling. Here, we report, after obtaining written consent, the cases of three patients who needed additional vaginal cerclage to prevent further funneling and membranous bulging despite intact laparoscopic cerclage material.

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