Laparoscopic Cervical Encerclage Rekindles Hope for Recurrent Miscarriage

From Heartbreak to Triumph: 

Author : Dr. Shwetha S Kamath 

Obstetrics and Gynecologist, Advanced Laparoscopy, Infertility & High-risk Pregnancy, Rainbow Children’s Hospital, Hebbal, Bengaluru 

Bangalore. Mrs. Renu (name changed) was pregnant for the sixth time, but this time, her emotions were a mix of joy and apprehension. The memories of her past pregnancies, filled with heartbreak and loss, haunted her, casting a shadow over her current experience. She was diagnosed with cervical incompetence, a condition in which the cervix, the mouth of the uterus, is weak and prone to premature opening. This premature opening typically occurs between the third and fifth month of pregnancy, leading to miscarriage. Desperate for a solution, Mrs. Renuhad sought help from multiple doctors and underwent various treatments, including strict bed rest, high doses of medications, and injections to support past pregnancies. She also underwent a cervical stitch or encerclage, a procedure performed through the vaginal route, but unfortunately, none of these interventions proved successful.

Determined to find a solution, Mrs. Renu's regular gynecologist referred her to Dr.Shwetha S. Kamath, Obstetrics and Gynecologist,Advanced Laparoscopy, Infertility & High-risk Pregnancyat Rainbow Children’s Hospital, Hebbal. With renewed hope, Mrs. Renu met Dr.Shwetha, who assured her that there was indeed hope for her situation. Dr.Shwetha proposed a laparoscopic encerclage, a procedure in which the cervix is stitched closed through minimally invasive surgery. After ensuring the baby's health at three months into the pregnancy, the laparoscopic encerclage was performed successfully. Mrs. Renu's pregnancy progressed smoothly, and at 38 weeks, she underwent a cesarean delivery, giving birth to a healthy baby.

“The percentage of miscarriages due to various factors is about 15%. About 80% occurs in the first trimester, the most common reason being genetic abnormalities in babies. Upto 5 % can happen in 2nd trimester and up to 25% of these may be due to cervical incompetence. If the medical management fails, vaginal encerclarge is offered. In failed vaginal encerclage, IVF conception, recurrent miscarriages, prolonged period of infertility, laparoscopic encerclage is suggested.”

“Laparoscopic encerclage does not prevent all 2nd-trimester miscarriage. It offers benefits in miscarriage due to cervical incompetence. It offers maximum benefit in cases where it is applied before pregnancy or soon after NT scan in pregnancy before the cervix opens.” Said Dr.Shwetha Kamath of the procedure. 

“In this case, the patient had a typical history suggesting cervical incompetence with failed medical management and vaginal encerclage. It offered her maximum benefit as it was applied soon after NT scan,” she added of the case. 

Cervical incompetence is a common cause of recurrent miscarriage, and initial treatments typically involve medications and encerclage performed through the vaginal route. However, laparoscopic cervical encerclage has proven to be a highly effective alternative in cases where these treatments fail. The procedure can be done either prior to pregnancy or during pregnancy itself, offering renewed hope to couples longing for a safe and successful pregnancy.