Transabdominal cervical cerclage.

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.