OBJECTIVE: Contemporary role of cerclage as a preterm birth treatment. DESIGN: Review article. SETTING: Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague. METHODS: Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method. RESULTS: Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management. CONCLUSIONS: Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.

• Klíčová slova
• cerclage, cervical insufficiency, cervicometry, preterm birth,
• MeSH
• cerkláž cervikální metody   MeSH
• cervix uteri chirurgie   MeSH
• inkompetence hrdla děložního diagnóza   chirurgie   MeSH
• lidé MeSH
• měření délky hrdla děložního MeSH
• předčasný porod prevence a kontrola   MeSH
• prenatální péče MeSH
• randomizované kontrolované studie jako téma * MeSH
• těhotenství MeSH
• vagina MeSH
• Check Tag
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

OBJECTIVE: In this work we report the first use of robot-assisted preconceptual abdominal cerclage in the Czech Republic with subsequent live birth. We present two patients with a history of late pregnancy losses (late miscarriage) who underwent robotic abdominal cerclage. DESIGN: Case report. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacký Univesity, Olomouc. METHODS: The da Vinci S surgical system was used for the robot-assisted abdominal cerclage. RESULTS: One robot-assisted laparoscopic transabdominal cerclage patient delivered at term a live infant and the second patient currently undergoes infertility treatment with in vitro fertilization. CONCLUSION: Robotic abdominal cerclage is a relatively new minimally invasive method for treatment of cervical insufficiency. This technique provides 3D visualization and better instrumentation than the conventional laparoscopic approach.

• Klíčová slova
• cervical insufficiency, laparoscopy, laparoscopy cervical insufficiency., robotic abdominal cerclage,
• MeSH
• cerkláž cervikální metody   MeSH
• dospělí MeSH
• inkompetence hrdla děložního chirurgie   MeSH
• laparoskopie * metody   MeSH
• lidé MeSH
• robotika * MeSH
• těhotenství MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Geografické názvy
• Česká republika MeSH

OBJECTIVE: The use of laparoscopic abdominal cerclage in a patient with habitual miscarriage. DESIGN: Case report and literature review. SETTING: Department of Obstetrics and Gynecology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Department of Neonatology, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc, Institute of Medical Genetics, University Hospital Olomouc, Faculty of Medicine, Palacký University Olomouc. CASE REPORT: The patient is a 37 years old woman with a history of recurrent miscarriages. She had one labor at term and six pregnancies that were lost in the second trimester despite McDonald cerclages. Abdominal cerclages are necessary when the standard transvaginal cerclages fail or anatomical abnormalities preclude the vaginal placement. The disadvantage of the transabdominal approach is that it requires at least 2 laparotomies with significant morbidity and hospital stays. We discuss a case of abdominal cerclage performed laparoscopically. A 5 mm Mersilene tape was placed laparoscopically at the level of the internal os as an interval procedure. We feel it offers less morbidity and in the proper hands eliminates or significantly shortens hospital stays. Subsequent pregnancy was terminated at 28 weeks by caesarean section after premature rupture of membranes. CONCLUSION: Laparoscopic abdominal cerclage seems to be relatively effective option for the prevention of habitual abortion patients, which fail conventional surgical procedures in dealing with cervical incompetence. The success of subsequent full term pregnancy is given as 70%.

• Klíčová slova
• cerclage, cervical incompetence., laparoscopy,
• MeSH
• cerkláž cervikální metody   MeSH
• císařský řez MeSH
• dospělí MeSH
• druhý trimestr těhotenství MeSH
• habituální potrat prevence a kontrola   chirurgie   MeSH
• inkompetence hrdla děložního chirurgie   MeSH
• laparoskopie metody   MeSH
• lidé MeSH
• novorozenec MeSH
• předčasný odtok plodové vody chirurgie   MeSH
• těhotenství MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH