Preconception laparoscopic transabdominal cervical cerclage for the prevention of midtrimester pregnancy loss and preterm birth: a single centre experience

BACKGROUND: A recent Cochrane review concluded that cervical cerclage reduces preterm birth before 37, 34 and 28 weeks of gestation and also probably reduces the risk of perinatal death. Transabdominal cerclage was developed for a subgroup in whom transvaginal cerclage had failed or was not possible. This approach appeared more effective in improving foetal survival rates or obstetric outcomes. Most commonly transabdominal cervical cerclage is placed at laparotomy (open transabdominal cerclage), but with the advance of minimal access techniques, laparoscopic transabdominal cervical cerclage is replacing the traditional open operation. The objective of this prospective case series is to explore the outcomes of pre-conception laparoscopic transabdominal cerclage procedures. METHOD: Data was prospectively collected from 54 women at high risk of second trimester miscarriage and preterm delivery due to cervical insufficiency undergoing pre-conception laparoscopic transabdominal cerclage by a single operator. This included demographics, obstetric and gynaecological history (including previous cervical cerclage procedures), surgical complication rates, conception and subsequent pregnancy outcomes. RESULTS: There were 36 pregnancies progressing beyond the first trimester with a “take home baby” rate of 89% (32/36), a live birth rate of 92% (33/36) and neonatal survival rate of 97% (32/33). The mid-trimester loss (MTL) rate was 8% (3/36) with delivery rates after 37 weeks of 75% (27/36) and between 34 -37 weeks of 8% (3/36) and 23-34 weeks of 8% (3/36). CONCLUSIONS: Our prospective case series provides further evidence that laparoscopic transabdominal cerclage (TAC) is feasible, safe and effective when transvaginal cerclage fails or is not possible.