Controversies in family planning: management of second-trimester losses in the setting of an abdominal cerclage

Dilation and evacuation with an abdominal cerclage at 21 weeks gestation: A case report

This case demonstrates a successful dilation and evacuation (D&E) at 21 weeks gestation for a patient with abdominal cerclage without initial advanced dilation. We followed a 2-day protocol with placement of 5 laminaria and mifepristone for cervical preparation without complication.

Dilation and evacuation after preterm premature rupture of membranes with abdominal cerclage in situ

For women with a history of cervical insufficiency, treatment with transvaginal (TV) or abdominal (TA) cerclage is often recommended; however management of pregnancy complications necessitating uterine evacuation in the second trimester are challenging. We present a patient at 17 weeks 3 day gestation with preterm premature rupture of membranes, and chorioamnionitis with an abdominal cerclage in situ. She desired uterine evacuation via dilation and evacuation. This case report reviews the clinical considerations for uterine evacuation in the second trimester in patients with an abdominal cerclage in situ and discusses options for cervical preparation prior to dilation and evacuation for this unique patient population.