Abdominal cerclage for the treatment of recurrent cervical insufficiency: laparoscopy or laparotomy?

Abstract

The purpose of this study was to compare the efficacy of traditional abdominal cerclage (AC) with laparoscopic cerclage (LC). Eligible women had at least 1 second trimester pregnancy loss due to cervical insufficiency, and had undergone at least 1 failed transvaginal cerclage. A prospective cohort of patients undergoing LC was compared with a historical control group of patients who had AC. A successful primary outcome was defined as delivery of a viable infant with neonatal survival. We were able to evaluate 19 pregnancies following unique abdominal cerclage placement, 12 laparoscopic and 7 at the time of laparotomy. Nine of 12 (75%) undergoing LC and 5 of 7 (71%) pregnancies undergoing AC successfully delivered a viable infant (P = .63). LC during pregnancy was successful in 4 of 5 (80%) cases as compared to 3 of 5 (60%) cases with AC during pregnancy (P = 1.0). Operative laparoscopy is a safe and effective alternative to laparotomy for the placement of abdominal cerclage.