Pregnancy outcomes following elective abdominal cerclage following cervical excision surgery for neoplastic disease

Local excisional treatment of neoplastic disease of the cervix in the form of loop excision (LLETZ) and conisation has been associated with adverse pregnancy outcomes including prelabour premature rupture of membranes (PPROM) and spontaneous preterm birth (SPTB). Insertion of a cervical cerclage is indicated for women with a short cervix <25 mm between 16 and 24 weeks gestation who also have a history of either PPROM or a history of cervical excisional treatment. The optimum timing of the cerclage and surgical technique used are both open to debate. This retrospective review of cases was performed to examine the outcomes of elective pre pregnancy placement of abdominal cervical cerclage in women who have undergone cervical excision surgery for neoplastic disease.

This was a retrospective review of case notes. Over a 10 year period 20 women who had previous cervical excision surgery had pre-pregnancy abdominal cerclage placed became pregnant with 26 pregnancies. One woman had a cone biopsy, 9 had a single LLETZ procedure, 8 had 2 LLETZ procedures and 2 women had 3 LLETZ procedures prior to the cerclage.

21 pregnancies were achieved spontaneously, 1 by intrauterine insemination (IUI) and 4 were conceived by in-vitro fertilisation (IVF). Overall, 22 of 26 (84.6 %) pregnancies were delivered at term. There was a single 7 week miscarriage and 3 premature deliveries (12 %) including 1 preterm birth at 29 + 4 weeks gestation after an antepartum haemorrhage (APH) and 2 late preterm births at 36 + 3 (following APH) and 36 + 4 weeks gestation following preterm labour. All 25 women were delivered by Caesarean section and all 25 babies survived.

There results of prophylactic minimally invasive insertion of a transabdominal cerclage in women with LLETZ treatments or cone biopsy prior to pregnancy demonstrated 84.6 % of pregnancies resulted in a live birth. The premature delivery rate was 12 %.