{"id":8662,"date":"2026-10-27T13:24:30","date_gmt":"2026-10-27T12:24:30","guid":{"rendered":"https:\/\/juanacrespo.com\/?post_type=caso&#038;p=8662"},"modified":"2026-10-27T13:24:30","modified_gmt":"2026-10-27T12:24:30","slug":"pregnancy-following-13-miscarriages-myomectomy-abdominal-and-laparoscopic-cerclage","status":"publish","type":"caso","link":"https:\/\/juanacrespo.com\/en\/case\/pregnancy-following-13-miscarriages-myomectomy-abdominal-and-laparoscopic-cerclage\/","title":{"rendered":"A full-term pregnancy with severe uterine factor infertility and recurrent pregnancy loss (13 miscarriages): Complex laparoscopic myomectomy, high abdominal cerclage"},"content":{"rendered":"<div>\n<h2><strong>1. Extract<\/strong><\/h2>\n<ul>\n<li><b>Patient Profile:<\/b> International patient referred from the United Kingdom with a history of extreme reproductive complexity: <b>13 pregnancy losses<\/b> (7 of which were late second-trimester losses due to severe cervical incompetence).<\/li>\n<\/ul>\n<ul>\n<li><b>Diagnostic Findings:<\/b> Macroscopically polymyomatous uterus with severe cavitary deformation, diffuse adenomyosis, enlargement of the uterus extending to the umbilical region, and a previous abdominal cerclage in a distal\/suboptimal position.<\/li>\n<li><b>Surgical and Medical Approach:<\/b><\/li>\n<\/ul>\n<ol>\n<li style=\"list-style-type: none;\">\n<ol>\n<li>OBTAINING a euploid embryo via <a href=\"https:\/\/juanacrespo.com\/en\/treatment\/in-vitro-fertilization\/\" target=\"_blank\" rel=\"noopener\">IVF<\/a>&#8211;<a href=\"https:\/\/juanacrespo.com\/en\/technique\/icsi\/\">ICSI<\/a> with <a href=\"https:\/\/juanacrespo.com\/en\/technique\/pgt\/\" target=\"_blank\" rel=\"noopener\">PGT-A<\/a> using the patient\u2019s own oocytes.<\/li>\n<li>Multiple <a href=\"https:\/\/juanacrespo.com\/laparoscopia-en-que-consiste-esta-tecnica-en-cirugia-reproductiva\/\" target=\"_blank\" rel=\"noopener\">laparoscopic<\/a> myomectomy (removal of 6\u20137 myomas whilst preserving the endometrium).<\/li>\n<li>REMOVAL and repositioning of <strong>laparoscopic abdominal cerclage via the high (isthmo-cervical) approach<\/strong>.<\/li>\n<li>\u00a0Hysteroscopy for review and endometrial regenerative treatment with PRP.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n<ul>\n<li><b>Obstetric Outcome:<\/b> Birth of a healthy live female infant at <b>34 weeks\u2019 gestation<\/b> via planned caesarean section in <b>June 2026<\/b>.<\/li>\n<\/ul>\n<h2><strong>2. Clinical History and Reproductive Anamnesis<\/strong><\/h2>\n<p>Patient with a reproductive history of high obstetric complexity characterised by repeated spontaneous pregnancies without a live-born infant.<\/p>\n<h1><strong>History of Pregnancy Losses:<\/strong><\/h1>\n<ul>\n<li><b>13 pregnancy losses in total:<\/b><\/li>\n<li><b>6 <\/b><a href=\"https:\/\/juanacrespo.com\/en\/problem\/recurrent-miscarriage\/\" target=\"_blank\" rel=\"noopener\"><b>miscarriages<\/b><\/a> in the first trimester.<\/li>\n<li><b>7 late pregnancy losses<\/b> (weeks 16 to 22) secondary to severe isthmocervical insufficiency.<\/li>\n<li><b>Assisted Reproductive Treatments:<\/b> 2 biochemical pregnancies following previous cycles.<\/li>\n<li><b>Previous Interventions:<\/b> Abdominal cerclage via laparotomy\/laparoscopy performed in 2019 in her country of origin, which failed to prevent subsequent pregnancy losses.<\/li>\n<\/ul>\n<\/div>\n<h2><\/h2>\n<div>\n<h2><strong>3. Anatomical Diagnosis of the Uterus<\/strong><\/h2>\n<p>On admission to our clinic, a comprehensive morphological assessment was carried out using three-dimensional (3D) ultrasound with hysterosonography and pelvic magnetic resonance imaging.<\/p>\n<h1><strong>Initial uterine diagnosis<\/strong><\/h1>\n<ul>\n<li>Polymyomatous uterus (umbilical volume)<\/li>\n<li><a href=\"https:\/\/juanacrespo.com\/que-es-la-adenomiosis-sintomas-causas-y-posibles-tratamientos\/\" target=\"_blank\" rel=\"noopener\">Adenomyosis<\/a> of the posterior uterine wall<\/li>\n<li>Severe deformation of the uterine cavity<\/li>\n<li>Previously performed, poorly positioned abdominal cerclage<\/li>\n<\/ul>\n<h2><strong>4. Main Findings<\/strong><\/h2>\n<ol>\n<li><b>Polymyomatous uterus and uterine adenomyosis:<\/b> Severely enlarged uterus (equivalent to a gestational age of 18\u201320 weeks, extending to the umbilical scar), with multiple leiomyomas of intramural and subendometrial distribution, associated with extensive posterior adenomyosis.<\/li>\n<li><b>Cavity Deformation:<\/b> Intrinsic compression and distortion of the endometrial cavity, preventing proper implantation and placental growth.<\/li>\n<li><b>Failure of Previous Cerclage:<\/b> The previous cerclage band was positioned too low (distally), rendering it ineffective in the face of the patient\u2019s mechanofunctional cervical incompetence.<\/li>\n<li><b>Step-by-Step Treatment Strategy<\/b><\/li>\n<\/ol>\n<p>Due to the extremely high risk of uterine rupture and implantation failure, a four-phase sequential protocol was designed:<\/p>\n<h3><strong>Phase 1: Embryo Genetic Testing and Obtaining a Euploid Embryo (October 2024)<\/strong><\/h3>\n<p>Before subjecting the patient to major invasive surgery, it was essential to ensure the genetic viability of the embryo.<\/p>\n<ul>\n<li><b>Ovarian Stimulation<\/b><b>:<\/b> 16 mature oocytes were retrieved.<\/li>\n<li><b>IVF + PGT-A:<\/b> <b>A single euploid (chromosomally healthy) embryo<\/b> was obtained. The entire subsequent strategy was designed to maximise the chances of success with this single embryo.<\/li>\n<\/ul>\n<h3><strong>Phase 2: Surgical Reconstruction of the Uterine Wall and Recerclage (March 2025)<\/strong><\/h3>\n<p>A <b>complex multi-level laparoscopic surgery<\/b> was performed:<\/p>\n<ol>\n<li><b>Laparoscopic myomectomy:<\/b> Enucleation of 6 to 7 large fibroids in the anterior and fundal walls, whilst preserving the integrity of the endometrial mucosa (without opening the uterine cavity).<\/li>\n<li><b>Correction of Cervical Incompetence:<\/b> Removal of the previous cerclage band and placement of a <b>new laparoscopic abdominal cerclage at the upper isthmocervical junction<\/b>, above the uterosacral ligaments.<\/li>\n<\/ol>\n<h3><strong>Phase 3: Hysteroscopic Optimisation and Endometrial Regenerative Therapy (July 2025)<\/strong><\/h3>\n<ul>\n<li><b>Surgical Resectoscopic Hysteroscopy:<\/b> Treatment of intra-cavitary scar tissue and release of microadhesions formed following myometrial surgery.<\/li>\n<li><b>Regenerative Treatment:<\/b> Intrauterine application of Revitalize <b>(PRP)<\/b> to restore the endometrial stroma damaged by myometrial pathology.<\/li>\n<\/ul>\n<h3><strong>Phase 4: Endometrial Preparation and <a href=\"https:\/\/juanacrespo.com\/en\/technique\/embryo-transfer\/\" target=\"_blank\" rel=\"noopener\">Embryo Transfer<\/a> (October 2025)<\/strong><\/h3>\n<ul>\n<li><b>Transfer:<\/b> On 22\/10\/2025, the single euploid embryo was devitrified and transferred under high-resolution ultrasound guidance, being placed atraumatically in the upper anterior wall of the endometrium.<\/li>\n<\/ul>\n<h2><strong>5. Outcome and Obstetric Course<\/strong><\/h2>\n<p><b>Pregnancy Test (\u03b2\ud835\udefd-hCG):<\/b> Positive with adequate doubling of plasma levels.<\/p>\n<ul>\n<li><b>High-Risk Pregnancy:<\/b> Referral for management to a Maternal-Fetal Medicine unit with fortnightly ultrasound scans, monitoring of cervical length and relative bed rest.<\/li>\n<\/ul>\n<ul>\n<li><b>Outcome of the Pregnancy:<\/b> In <b>June 2026<\/b>, upon reaching <b>34 weeks\u2019 gestation<\/b> and after confirming foetal lung maturity, a <b>scheduled elective caesarean section<\/b> was performed, resulting in the birth of a healthy baby girl with no immediate neonatal complications.<\/li>\n<\/ul>\n<h2><strong>6. Conclusions and Clinical Relevance<\/strong><\/h2>\n<p>This case represents one of the most complex scenarios in reproductive and maternal medicine:<\/p>\n<ol>\n<li><b>Efficacy of High Abdominal Cerclage in Severe Cervical Incompetence:<\/b> Laparoscopic correction and repositioning of the cerclage at the level of the uterine isthmus is the technique of choice when previous vaginal or abdominal cerclages have failed.<\/li>\n<li><b>Conservative Uterine Reconstructive Surgery:<\/b> It is possible to perform multiple myomectomies on uteri severely deformed by adenomyosis and fibroids without compromising the endometrial cavity, thereby enabling subsequent full-term pregnancies.<\/li>\n<li><b>Optimisation with a Single Embryo:<\/b> The combination of <b>PGT-A + Structured Surgery + Endometrial Regenerative Medicine (PRP)<\/b> enables success rates of 100 per cent per transfer to be achieved, even in cases where only a single euploid embryo is available.<\/li>\n<\/ol>\n<\/div>\n","protected":false},"featured_media":8680,"template":"","meta":{"_acf_changed":false,"content-type":""},"categoria-de-caso":[470,471],"class_list":["post-8662","caso","type-caso","status-publish","has-post-thumbnail","hentry","categoria-de-caso-aborto-de-repeticion","categoria-de-caso-laparoscopia"],"acf":[],"_links":{"self":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso\/8662","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/caso"}],"about":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/types\/caso"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media\/8680"}],"wp:attachment":[{"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/media?parent=8662"}],"wp:term":[{"taxonomy":"categoria-de-caso","embeddable":true,"href":"https:\/\/juanacrespo.com\/en\/wp-json\/wp\/v2\/categoria-de-caso?post=8662"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}