Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study

Abstract

Objective: To evaluate the effect of laparoscopic abdominal cerclage performed as an interval procedure in non-pregnant women at high risk of second trimester spontaneous abortion and early preterm birth.

Design: Observational study.

Sample: Fifty-two consecutive patients at high risk of preterm birth.

Setting: Department of Obstetrics and Gynecology, Aarhus University Hospital.

Methods: Patients were registered prospectively. Indications for surgery included classical cervical insufficiency, preterm premature rupture of membranes (PPROM) or two conizations/cervical amputation. Outcome of subsequent pregnancies was registered.

Main outcome measures: Gestational age in subsequent pregnancies.

Results: No operative or postoperative complications were observed. A total of 45 pregnancies were registered during the observation period. Among 36 pregnancies lasting beyond the 16th week of gestation, 30 women (83.3%) gave birth by cesarean section after 36 weeks of gestation and the overall mean gestational age was 37.4 weeks compared with a mean gestational age of 25.2 weeks of the pregnancies prior to the cerclage. The cesarean sections were uncomplicated in all but one patient, where a re-laparotomy was needed six hours later due to atonic postpartum hemorrhage without evident bleeding through the cervix.

Conclusion: Laparoscopic abdominal cerclage is a feasible and safe procedure. Obstetrical outcomes are encouraging but prospective studies are needed to define the effectiveness of the laparoscopic cerclage compared with the traditional transvaginal approach.