What is the procedure for abdominal cerclage?

Abdominal Cerclage

1. Patient Preparation:

- Obtain informed consent.

- Administer antibiotics to prevent infection.

- Insert a urinary catheter.

2. Positioning:

- Place the patient in the supine position with a slight Trendelenburg tilt.

3. Skin Preparation and Draping:

- Prepare the abdomen and pubic area with an antiseptic solution.

- Drape the surgical field.

4. Incision:

- Make a transverse or midline incision just above the pubic bone.

5. Exposure of the Uterus:

- Bluntly dissect through the abdominal layers to expose the uterus.

6. Placement of Uterine Stay Sutures:

- Place two stay sutures on the upper part of the uterus, one on each side.

- These sutures will be used to manipulate and stabilize the uterus during the procedure.

7. Cerclage Material Selection:

- Choose the appropriate cerclage material, such as Mersilene tape or nylon sutures.

8. Cerclage Placement:

- Insert a round-tipped needle through the myometrium of the uterus, entering close to the uterine serosa.

- Pass the needle through the myometrium and out through the serosa on the opposite side.

- Repeat this process on both sides of the uterus.

- Tie the sutures securely to create the cerclage.

9. Confirmation of Cerclage Position:

- Use ultrasound or direct visualization to confirm that the cerclage is placed properly.

10. Closure:

- Irrigate the surgical site.

- Close the abdomen in layers with absorbable sutures.

11. Post-operative Care:

- Monitor the patient for any complications.

- Administer pain medication as needed.

- Provide instructions on wound care and activity restrictions.

Note: The specific technique for abdominal cerclage may vary based on the preferences of the surgeon and the individual patient's circumstances.