Ades Alex, Mor Omer
University of Melbourne, Melbourne, Australia (Dr Ades); Royal Women's Hospital, Melbourne, Australia (Dr Ades); Agora Specialist Center, Epworth Hospital, Melbourne, Victoria (Drs Ades and Mor).
Agora Specialist Center, Epworth Hospital, Melbourne, Victoria (Drs Ades and Mor)..
J Minim Invasive Gynecol. 2025 Oct;32(10):935-940. doi: 10.1016/j.jmig.2025.07.003. Epub 2025 Jul 10.
Cervical insufficiency is recognized as an important cause of obstetric morbidity and mortality, leading to midtrimester loss and preterm birth. Laparoscopic transabdominal cerclage is one of the proposed interventions to manage this condition. The study reports on a large series of pregnancies with laparoscopic transabdominal cerclage to assess its effectiveness.
This study evaluates laparoscopic transabdominal cerclage as a procedure to improve obstetric outcomes in patients diagnosed with cervical insufficiency. It is a retrospective observational study of consecutive patients who underwent laparoscopic transabdominal cerclage between August 2007 and July 2024.
The research was conducted in Melbourne, Australia, in several public and private healthcare facilities.
Eligible patients had a diagnosis of cervical insufficiency based on previous obstetric history and were referred for a laparoscopic transabdominal cerclage. The indications for a transabdominal cerclage were a previous failed vaginal procedure, previous oncologic surgery that removed large portions of the cervix, and multiple midtrimester pregnancy losses because of cervical insufficiency. All patients were entered on a database and were prospectively followed up during subsequent pregnancies. The primary outcome was neonatal survival, and the secondary outcome was delivery of an infant at ≥34 weeks' gestation.
Surgical laparoscopic transabdominal cerclage.
During the period of the study, 512 patients underwent a laparoscopic transabdominal cerclage following a clinical diagnosis or concerns of cervical insufficiency. We present the outcomes of 524 pregnancy reports among 414 patients to date. Neonatal survival was 96.4%, with 85.7% of neonates delivered at >34 weeks gestation. Less than 0.5% of the laparoscopic transabdominal cerclage surgeries had surgical complications or documented morbidity.
Laparoscopic transabdominal cerclage is a successful management option for patients with concerns of cervical insufficiency and complex obstetric and gynecological histories. This large cohort study shows positive neonatal outcomes and low surgical morbidity.
宫颈机能不全被认为是产科发病和死亡的重要原因，可导致孕中期流产和早产。腹腔镜经腹宫颈环扎术是针对该病症的一种建议干预措施。本研究报告了一系列接受腹腔镜经腹宫颈环扎术的妊娠情况，以评估其有效性。
本研究评估腹腔镜经腹宫颈环扎术作为改善诊断为宫颈机能不全患者产科结局的一种手术方法。这是一项对2007年8月至2024年7月期间连续接受腹腔镜经腹宫颈环扎术患者的回顾性观察研究。
该研究在澳大利亚墨尔本的几家公立和私立医疗机构进行。
符合条件的患者根据既往产科病史被诊断为宫颈机能不全，并被转诊接受腹腔镜经腹宫颈环扎术。经腹宫颈环扎术的指征包括既往阴道手术失败、既往因肿瘤手术切除大部分宫颈，以及因宫颈机能不全导致多次孕中期妊娠丢失。所有患者均录入数据库，并在随后的妊娠期间进行前瞻性随访。主要结局是新生儿存活，次要结局是孕34周及以上分娩婴儿。
手术性腹腔镜经腹宫颈环扎术。
在研究期间，512例患者在临床诊断或怀疑宫颈机能不全后接受了腹腔镜经腹宫颈环扎术。我们展示了截至目前414例患者中524份妊娠报告的结局。新生儿存活率为96.4%，85.7%的新生儿在孕34周以上分娩。腹腔镜经腹宫颈环扎术手术并发症或有记录的发病率低于0.5%。
对于担心宫颈机能不全且有复杂妇产科病史的患者，腹腔镜经腹宫颈环扎术是一种成功的治疗选择。这项大型队列研究显示了良好的新生儿结局和较低的手术发病率。
