Reproductive System & Sexual Disorders: Current Research
Open Access

Lamentin's Role in the Management of Cervico-Isthmic Incompetency

^*Correspondence: Jacob Reece, Department of General Medicine, Bareilly International University, India, Email:

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About the Study

Prematurity is the greatest cause of illness and death among newborns. The cervico isthmic gap is one of the primary reasons. It is a cervico-isthmic zone aberration characterized by the inability of the cervix's internal opening to function as a sphincter during pregnancy, either due to traumatic damage of its muscular fibers or due to their constitutional or congenital deficiency [1]. According to McDonald, one-fifth of recurrent abortions in the second trimester are caused by cervico-isthmic incompetence. A history of recurrent delayed miscarriage and early birth, as verified by the Hegar candle test and hysterography, led to his diagnosis [2]. For many years, the therapy of the cervico isthmic gap has relied on cervical cerclage during pregnancy, either prophylactically or in an emergency. However, in certain circumstances, strapping is ineffective, and it is feasible to enhance the prognosis of these pregnancies by performing cervical plasties prior to conception, most often through laparotomy. In order to enhance the functional prognosis of the cervical isthmic apparatus, we conducted vaginal cervical plasty in patients with an obstetric history of abortive illness and preterm birth at the General Hospital of Lamentin in Martinique [3,4].

This consisted of qualitative and quantitative research conducted over a 20-year period in the Department of Obstetric Gynecology at the Lamentin Hospital Centre in Martinique. We included the data of patients who had been diagnosed with cervical incompetence [5]. Before the conception, he had cervical plasty via vaginal channel, according to a method developed at Lamentin Hospital. The cervical plasty was finished by strapping between the tenth and fourteenth weeks of pregnancy using MacDonald's approach. The diagnosis of cervico isthmic gap was based on anamnestic and paraclinical evidence, namely an appraisal of the usable length of the neck less than 25 mm, the candle Number 8 test, and hysterography [6,2]. Patients who were included in the study had a history of at least two late spontaneous miscarriages or preterm deliveries of less than 34 weeks of amenorrhea, at least one of which occurred despite preventative or therapeutic strapping. The research excluded patients who had strapping during pregnancy that was not followed by abdominal cervical plasty. Before surgery, a thorough preoperative evaluation was carried out. The cervical surgery was performed by top specialists using a unique service approach [7].

Anaesthesia was administered and a 5 mm transverse anterior colpotomy was done below the vesico-cervical junction, about 5 mm below the vesico cervical groove. Hey then performed a vesicouterine dissection to the isthmus, followed by a superiorbase triangle resection beginning from the internal orifice of the neck with incisions at 11^th and 13^th and whose apex ends on the cervical orifice external; This allows for a narrowing of the cervical canal, particularly at the level of the internal orifice [8,5].

Suturing in two planes from top to bottom by distinct locations was used for the rebuilding. As a guardian, a catheter with a serial number was put in the uterus and withdrawn three or four days later. When the front of the sac was open, a Delbert blade was used to drain the anterior detachment. Between the tenth and 14^th weeks of amenorrhea, further strapped using the MacDonald method was undertaken. The records of the patients who met the criteria were comprehensive, and the data was obtained by tabulation. The factors evaluated were sample features, medical and gynecological and obstetric history, period between plastic surgery and conception, pregnancy course, pregnancy outcome, and method of delivery [9].

Cervicovaginal plasty done prior to conception and augmented with conventional strapping in the first trimester has yielded good results in women with an abortive disease by cervico isthmic gap in terms of improved pregnancy prognosis. However, inferences concerning the sample size and type of study are not achievable. Nonetheless, it offers up new possibilities and may add to the therapeutic arsenal available to obstetricians and gynecologists in the management of women who have demonstrated cerebral incompetence.

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