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

Riiskjaer, Mads; Petersen, Olav B; Uldbjerg, Niels; Hvidman, Lone; Helmig, Rikke B; Forman, Axel

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.