Transabdominal cervical cerclage

Abstract

Background: Transabdominal cervical cerclage has been performed via laparotomy for over four decades. A laparoscopic approach has recently been developed and offers the potential for lower morbidity.

Aims: The experience of one operator with transabdominal cervical cerclage via laparotomy is reviewed to establish a baseline with which to compare results from the laparoscopic approach.

Methods: Transabdominal cervical cerclage was performed with Mersilene tape. The pregnancy outcome prior to transabdominal cervical cerclage was compared with the outcomes after its insertion.

Results: Prior to transabdominal cervical cerclage, there were 58 pregnancies of which 18 ended with a first trimester pregnancy loss. Twenty-eight of the 36 pregnancies delivering between 13- and 26-week gestation resulted in a pregnancy loss. Three of the four children delivered after 26-week gestation survived. Following transabdominal cervical cerclage, there were no first trimester pregnancy losses. Of the 23 pregnancies after transabdominal cerclage, one was terminated at 18-week gestation for spina bifida and the remaining 22 babies were delivered at a mean gestation of 36.2 weeks. Maternal morbidity was limited to a single wound infection. Respiratory distress was the only significant neonatal morbidity with all babies recovering completely.

Conclusions: Transabdominal cervical cerclage via laparotomy is a safe and successful method of treating women who need a cervical cerclage but are unable to have a vaginal suture. A baseline has been established with which to compare the results from laparoscopic transabdominal cervical cerclage in the future.