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Abdominal cerclage, a rare procedure, lets mom deliver another daughter

Cynthia Coniglio has two girls — a healthy newborn and a 22-month-old with special needs. She also has, no surprise, a bad case of sleep deprivation.

But ask about what she has endured to have her babies, and her intensity is clear.

"If I can save other moms from what I've been through, and help babies live, I'm going to talk my little face off,'' the 38-year-old Hernando County mom told me.

What she has been through is nothing short of heartbreak.

A few years ago, she was four months pregnant when her water broke. Her son was stillborn.

In 2010, she was pregnant again. Her doctor diagnosed "cervical insufficiency,'' meaning her cervix couldn't support a full-term pregnancy. She received the standard treatment — cerclage, a single suture placed through the vagina to hold her cervix in place while the baby developed.

Baby Clover, named for the luck that plant symbolizes, still arrived far too early, at less than five months' gestation. She spent more than five months at the neonatal intensive care unit at St. Joseph's Children's Hospital in Tampa.

Clover, who turns 2 in January, has chronic lung disease. She has had heart surgery and must be monitored for fluid on her brain. She still is not talking.

"It changes you,'' Coniglio said of the experience of watching a tiny baby struggle. "In the NICU, her right lung collapsed twice, her kidneys shut down.''

Coniglio thought she couldn't conceive again, but discovered this year that she was wrong.

She searched the Internet for help and called for an appointment with USF Health's Maternal Fetal Medicine team at Tampa General Hospital.

"I figured being a teaching hospital, they're going to be up to date. They will know how to save this pregnancy,'' she explained.

Still, she added, "I was expecting them to say, 'Sorry, we can't help you.' "

She met Dr. Valerie Whiteman, interim director of maternal-fetal medicine at USF Health.

"When I saw Cynthia, I realized that even though I do many vaginal cerclages, that wasn't an option.'' Possibly due to a surgery years ago to treat a precancerous condition, possibly because of damage during Clover's birth, Coniglio's cervix was so short, "there was nothing to put a suture in,'' Whiteman said.

She proposed a different kind of cerclage, in which the surgeon goes through the abdomen to place the suture high on the cervix to keep it closed. It's a rare procedure — few women need it, as the vaginal cerclage often is successful. And few doctors know how to do it.

It can be done as an open procedure, through an incision made along the bikini line. But Whiteman and her colleague, Dr. Lennox Hoyte, director of urogynecology and an expert in laparoscopic gynecological surgery using the da Vinci robot, decided it would be safer to use a minimally invasive approach.

Tiny cameras and instruments were slipped into Coniglio's abdomen through small incisions. Hoyte manipulated the instruments remotely, using devices similar to joysticks and visualizing the progress with video monitors.

"The beauty of the da Vinci is that it can go into tiny little places our hands can't go,'' Whiteman explained.

Coniglio had the procedure in June, just over 12 weeks into her pregnancy. For the first time at Tampa General, a robot was used in an abdominal cerclage, making a bit of local medical history.

After that, her pregnancy proceeded normally. Raven, at a hearty 6 pounds, 14 ounces and with a full head of dark hair, arrived by C-section on Oct. 23.

Whiteman doesn't expect this procedure to become common — Coniglio's is still the only one ever at TGH. But she was glad to hear her patient is speaking out, as her story carries larger messages for women who have lost pregnancies.

"Oftentimes patients keep going back to same provider, and I understand that, but we may be able to assist with things other people can't,'' Whiteman said of academic medical centers like hers.

"The other take-home message here is that having a loss after a cerclage does not mean you'll never have a successful pregnancy again,'' she said.

"If Cynthia thought that, little Raven wouldn't be here.''

Charlotte can be reached at sutton@tampabay.com or (727) 893-8425.

Charlotte Sutton I Health and medicine editor

Terry Tomalin I Outdoors/fitness editor

Jan Brackett I Designer

Melissa Lyttle I Cover photo of Bret Applefield, Mike Frazier and Spike Fry

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Abdominal cerclage, a rare procedure, lets mom deliver another daughter 11/02/12 [Last modified: Friday, November 9, 2012 3:49pm]
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