Comparison of transvaginal cervical cerclage versus laparoscopic abdominal cervical cerclage in cervical insufficiency: a retrospective study from a single centre

Abstract

Background Cervical cerclage has been proposed as an effective treatment for cervical insufficiency, but there has been controversy regarding the surgical options of cervical cerclage in singleton and twin pregnancies. This study aimed to compare the pregnancy outcomes between transvaginal cervical cerclage (TVC) and laparoscopic abdominal cervical cerclage (LAC) in patients with cervical insufficiency. We also aimed to evaluate the efficacy and safety, and provide more evidence to support the application of cervical cerclage in twin pregnancies. Methods A retrospective study was carried out from January 2015 to December 2021. The primary outcomes were the incidence of spontaneous preterm birth (sPTB) < 24 weeks, < 28, < 32, < 34 weeks, and < 37weeks, gestational age at delivery, and the incidence of admission for threatened abortion or preterm birth after cervical cerclage. The secondary outcomes included admission to the Neonatal Intensive Care Unit, adverse neonatal outcomes and neonatal death. We also analysed the pregnancy outcomes of twin pregnancies after cervical cerclage. Results A total of 289 patients were identified as eligible for inclusion. The LAC group (n = 56) had a very low incidence of sPTB ˂ 34 weeks, and it was associated with a significant decrease in sPTB < 28 weeks, ˂32 weeks, ˂34 and < 37 weeks, and admission to the hospital during pregnancy for threatened abortion or preterm birth after cervical cerclage (0 vs.27%; 1.8% vs. 40.3%; 7.1% vs. 46.8%; 14% vs. 63.5%, 8.9% vs. 62.2%, respectively; P < 0.001), and high in gestational age at delivery compared with the TVC group (n = 233) (38.3 weeks vs.34.4 weeks,P < 0.001). Neonatal outcomes in the LAC group were significantly better than those in the TVC group. The mean gestational age at delivery was 34.3 ± 1.8 weeks, with a total foetal survival rate of 100% without serious neonatal complications in twin pregnancies with LAC. Conclusion In patients with cervical insufficiency, LAC appears to have better pregnancy outcomes than TVC. For some patients, LAC is a recommended option and may be selected as the first choice. Even in twin pregnancies, cervical cerclage can improve pregnancy outcomes with a longer latency period, especially in the LAC group.

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: a retrospective study from a single centre

“…Patients in the physical examination-indicated cerclage group had a shorter cervical length at cerclage accompanied by cervical dilation, which may be related to poor pregnancy outcomes. Moreover, the majority of patients in the physical examination group with advanced dilatation and membrane bulging through the external cervical os, which directly comes into contact with vaginal flora, are more likely to have infection, and infection is a significant risk factor leading to preterm birth [ 23 ].…”

Effectiveness and pregnancy outcomes of ultrasound-indicated and physical examination-indicated cervical cerclage: A retrospective study from a single centre

“…Patients in the physical examination-indicated cerclage group had a shorter cervical length at cerclage that was accompanied by cervical dilation, which may be related to poor pregnancy outcomes. Moreover, the majority of patients in the physical examination group with advanced dilatation and membrane bulging through the external cervical os, which directly comes into contact with vaginal ora, are more likely to have infection, and infection is a signi cant risk factor leading to late abortion and premature birth [20] . Even before and during surgery, vaginal bacteria have already retrograded from the dilated cervical canal into the uterine cavity.…”

Perinatal complications following excisional treatment of cervical dysplasia

“…Both laparotomic, laparoscopic and robotic approach can be used, and it can be performed during pregnancy and preconceptionally (57). This procedure requires at least two additional surgeries and is not widely used in patients treated with cervical conization, although TAC might present a useful tool in rare cases of deep and/or extensive cervical excisions complicated with cervical insufficiency and when other less invasive procedures have failed (58). In order to proclaim it as safe and feasible for this purpose, further research is required.…”