[Transabdominal cervico-isthmic cerclage: 13 cases at Rouen University Hospital]

Area of Science:

• Reproductive Medicine
• Obstetrics
• Surgical Innovation

Background:

• Cervical incompetence poses a significant risk for pregnancy loss.
• Transvaginal cerclage is a common treatment, but can fail in some cases.
• Transabdominal cerclage offers an alternative for managing recurrent cervical incompetence.

Purpose of the Study:

• To describe the experience and assess the efficacy of transabdominal cervico-isthmic cerclage.
• To compare laparotomy and laparoscopic approaches for this procedure.
• To evaluate patient outcomes following transabdominal cerclage.

Main Methods:

• Retrospective analysis of 13 transabdominal cerclages (8 laparotomy, 5 laparoscopy) performed between 2004-2009.
• Analysis included prior obstetric history, etiology of cervical incompetence, and post-cerclage outcomes.
• Patients underwent cerclage either before pregnancy or between 12-14 weeks gestation.

Main Results:

• Median patient age was 35 years, with an average of 4.2 pregnancies and 3.3 prior pregnancy losses or preterm deliveries.
• Eighty percent of patients had a history of failed transvaginal cerclage.
• Eleven women achieved pregnancy post-cerclage, with 9 term C-sections and 2 preterm births (34-37 weeks). No operative complications were reported.

Conclusions:

• Transabdominal cervico-isthmic cerclage is a viable alternative for managing cervical incompetence after failed transvaginal cerclage.
• Laparoscopic placement demonstrates favorable operative times and reduced hospitalization compared to laparotomy.
• This technique shows promise for improving pregnancy outcomes in high-risk patients.