Procedure:McDonald's cerclage placement

Diagnosis:Intrauterine pregnancy at 12 weeks, history of cervical incompetence

Anesthesia:Epidural

History:The patient is a 36-year-old gravida 3 para 2 with a last menstrual period (LMP) on January 28. Positive HCG was noted on March 1. Intrauterine pregnancy was determined to be at 12 weeks by time of LMP and at first trimester by ultrasound. She has a history of cervical incompetence in a previous pregnancy that was brought to term with a cerclage. She also has a history of diethylstilbestrol exposure and of cerclage placement times 2, D&C times 2, and umbilical herniorrhaphy.

Finding and Techniques:Preoperatively, her internal os was approximately 1 cm dilated. The posterior cervix was approximately 2 cm long, and the interior cervix was approximately 1 cm long. At the end of the procedure, the knot could be felt at the 12 o'clock position and the internal os was closed to digital examination.

The patient was in the dorsal lithotomy position. She had internal and external perineal preps and was draped for the procedure. A Mersilene band on two needles was used with one needle placed in at the 6 o'clock position and brought out at 3 o'clock, and replaced at the same position and brought out at 12 o'clock. The other needle was taken in at 3 o'clock and brought out at 9 o'clock, and then replaced and brought out at 12 o'clock. The Mersilene band then was tied at the 12 o'clock position until the internal os was closed. It was palpable at the end of the procedure, and the two ends were cut long. The patient received perioperative antibiotics, and her heart tones were Dopplerable before the procedure. The procedure was without complications, and the patient was taken to the recovery room in stable condition.