Modifications to the modified Shirodkar operation

In cases of cervical incompetence, the Shirodkar procedure is occasionally necessary when the McDonald procedure cannot be used due to poor cervical a natomic conditions. We have further facilitated a modified Shirodkar proced ure with some modifications. A transverse incision over the anterior lip of the cervix is made and the bladder is separated from the cervix. One end o f an atraumatic forceps is introduced deeply into the space between the bla dder and the cervix, and the other end is pushed against the posterior forn ix to grasp paracervical tissues, so that a needle is easily passed through at the tip of the forceps. The knot is placed anteriorly and a silk thread is passed around the tape in the posterior fornix to facilitate removal of the tape. This procedure resulted in no complications and greatly facilita ted removal of the tape, resulting in a cervical cerclage which was compara tively easily carried out.