[Transvaginal cervico-isthmic cerclage using polypropylene tape: Surgical procedure and pregnancy outcome]

To assess the efficacy of performing transvaginal cervicoisthmic cerclage (CIC) using synthetic tape in prevention of preterm labor in high-risk women.

A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerclage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route.

The median age of the patients in this series was 33.2 years (range 25-41 years). No intra-operative complication occurred. The median operating time was 36.9 minutes (±4.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Term birth rate was 57.5% (3% before CIC; p<0.0001). Pregnancy loss in the second trimester was 7.8% (66% before CIC; p<0.0001). Preterm birth rate was 23.1% (31% before CIC). Birth at less than 28 weeks occurred in only 1patients (3.7%) (10.7% before CIC). In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases (5%). Living birth rate was 80.7% (21% before CIC) and no neonatal death occurred (13% before CIC).

Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.