非妊娠時の腹腔鏡下頸管縫縮術後に健児を得た一例

抄録

Introduction: Prophylactic laparoscopic cervical cerclage is commonly performed in Western countries in women with prior failed transvaginal cervical cerclage or iatrogenic cervical shortening. However, this approach has not been reported in Japan. We report a case of laparoscopic cervical cerclage (LCC) in a non-pregnant woman.

Case: A 37-year-old woman who underwent a previous cesarean section underwent laparoscopic repair of a cesarean section scar (laparoscopic removal of scar tissue and resuturing) in x-2 for infertility secondary to cesarean scar syndrome. Extensive scar tissue resection causes cervical shortening and might predispose to miscarriage and premature delivery. Our patient conceived naturally in x-1; however, she developed rupture of membranes at week 17 and underwent a miscarriage. She once again conceived naturally 5 months later. She developed cervical shortening at week 13, and underwent transvaginal cervical cerclage at week 16. Premature rupture of membranes led to miscarriage at week 20. Following informed consent, we performed LCC during the non-pregnant state in x. She conceived after ovulation induction in x+1 and was hospitalized for cervical shortening at week 25. At week 31, she underwent emergency cesarean section following a high rupture of membranes. Currently, the infant is 10 months old without any developmental issues.

Discussion: We report successful LCC during the non-pregnant state in a woman who delivered a preterm but otherwise healthy neonate. LCC during the non-pregnant state might be an effective strategy in women with failed transvaginal cervical cerclage during pregnancy.