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Published on: September 13, 2022
Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study
Nicole B Burger1, Jon I Einarsson, Henricus A M Brölmann
1Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands. n.burger@vumc.nl
Insights
Preconceptional laparoscopic abdominal cerclage is effective in preventing recurrent preterm birth. This procedure resulted in 71.4% of patients delivering at ≥ 34 weeks gestation, with a 90% fetal survival rate.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Minimally Invasive Surgery
Background:
- Recurrent preterm birth due to cervical insufficiency poses significant risks to fetal survival.
- Previous treatments for cervical insufficiency have varying success rates.
- Laparoscopic abdominal cerclage offers a minimally invasive surgical approach.
Purpose of the Study:
- To evaluate the effectiveness of laparoscopic abdominal cerclage in preventing recurrent preterm birth.
- To assess perinatal outcomes following preconceptional laparoscopic abdominal cerclage.
- To analyze surgical and pregnancy outcomes in women with a history of cervical insufficiency.
Main Methods:
- A multicenter retrospective cohort study involving 66 patients who underwent preconceptional laparoscopic abdominal cerclage.
- Inclusion criteria: history of second/third trimester fetal loss or delivery <34 weeks due to cervical insufficiency.
- Primary outcome: delivery at ≥ 34 weeks gestation with neonatal survival; secondary outcomes: surgical/pregnancy complications, patient satisfaction.
Main Results:
- Excellent surgical outcomes with only 3 minor complications among 66 patients.
- In 35 evaluated pregnancies, 71.4% resulted in delivery at ≥ 34 weeks gestation.
- Overall fetal survival rate was 90.0%, with 8.6% experiencing second-trimester fetal loss.
Conclusions:
- Preconceptional laparoscopic abdominal cerclage demonstrates favorable perinatal outcomes.
- The procedure is effective in improving fetal survival rates for patients with a history of recurrent preterm birth.
- Laparoscopic abdominal cerclage is a promising option for managing cervical insufficiency.
Objective:
The purpose of this study was to evaluate the effectiveness of laparoscopic abdominal cerclage placement in the prevention of recurrent preterm birth.
Study Design:
We conducted a multicenter cohort study with retrospective Dutch (32 patients) and Boston (34 patients) cohorts who had undergone preconceptional laparoscopic abdominal cerclage placement. Eligible patients had at least 1 second/third trimester fetal loss or delivered at <34 weeks of gestation because of cervical insufficiency and/or a short or absent cervix. Primary outcome was delivery of an infant at ≥ 34 weeks of gestation with neonatal survival. Secondary outcome measures included surgical and pregnancy outcomes and patients' satisfaction (Dutch cohort).
Results:
Surgical outcomes of 66 patients were excellent, with 3 minor complications. After preconceptional laparoscopic abdominal cerclage, 35 pregnancies were evaluated. Twenty-five patients (71.4%) delivered at ≥ 34 weeks of gestation; 3 patients (8.6%) experienced a second-trimester fetal loss. The total fetal survival rate was 90.0%.
Conclusion:
Preconceptional laparoscopic abdominal cerclage shows encouraging and favorable perinatal outcomes in patients with a poor obstetric history.
