Year: 2008
Type: conference-abstract
Abstract: The ultrasonographic findings of a fourteen-week gestation in a woman with a history of a prior cervical cerclage, demonstrate a spontaneous abortion through a cervicovaginal fistula. A 36 year-old gravida 13, para 0-1-12-0, with a history of cervical incompetence presented at 14 weeks' gestation for a prophylactic Shirodkar cerclage. The most recent delivery occurred at 22 weeks after a failed prophylactic McDonald cerclage placed at 14 weeks and subsequent rescue McDonald cerclage placed at 20 weeks. At presentation she gave a two-day history of cramping and spotting. Because of the concern for spontaneous abortion, the prophylactic cerclage procedure was postponed and she was referred for ultrasound follow-up three days later. A transvaginal ultrasound revealed the external cervical os as closed and the amniotic sac appeared to be protruding through the posterior wall of the cervix (Figure 1). Bimanual and vaginal speculum exam verified that the amniotic sac was protruding through a defect in the posterior wall of the cervix into the vaginal vault through a defect most likely related to prior laceration. The pregnancy was interrupted by an uncomplicated dilatation and evacuation. Follow-up assessment of her endometrial cavity by saline infusion sonohysterograhy was normal. She later desired to proceed with prophylactic abdominal cerclage placement, which was performed without difficulty. This case demonstrates a cervicovaginal fistula occurring in a woman with cervical incompetence with prior failed cervical cerclage. The ultrasound findings suggest a need for a high index of suspicion for identifying cervicovaginal fistula in a woman with a prior cervical cerclage. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
DOI: 10.1002/uog.6088
Authors: C. A. Grotegut, L. R. Brancazio, N. Moore, K. Reddick, B. J. Canzoneri, B. Fitzpatrick, T. R. Beiswenger, M. Small, B. K. Boyd, A. P. Murtha, H. L. Brown
Institution: Duke University
Language: English
Subfield: Obstetrics and Gynecology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W1966655260