Laparoscopic Transabdominal Cervicoisthmic Cerclage during Pregnancy

Abstract

Study Objective. To evaluate and describe our experience in the management of recurrent second-trimester miscarriage and preterm delivery by laparoscopic transabdominal cervicoisthmic cerclage (LTCC), after failure of transvaginal cervical cerclage. Design. Retrospective review (Canadian Task Force classification III). Setting. Tertiary care teaching hospital. Patients. Twenty women in whom it was not technically possible to perform transvaginal cerclage. Intervention. LTCC. Measurements and Main Results. Mean operating time was 55 minutes (range 40–75 min). There were no operative or immediate postoperative complications. Mean gestational age at the time of cerclage placement was 12.1weeks (range 11–14wks). Nineteen women successfully delivered 21 live babies (2 sets of twins; live birth rate 95%). One loss occurred after rupture of membrane at 19 weeks’ after cerclage. Conclusion. LTCC during pregnancy can be safe and effective treatment for well-selected patients with cervical incompetence, and eliminates the need for open laparotomy.