Cervical Insufficiency Management with Elective Transvaginal Cervicoisthmic Cerclage

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Surgical Innovation

Background:

• Transabdominal cervicoisthmic cerclages (TACIC) are recommended for cervical insufficiency refractory to vaginal cerclages or in cases of an anatomically short cervix.
• Previous cervical cerclage failure necessitates alternative management strategies to prevent preterm birth.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of transvaginal cervicoisthmic cerclage (TVCIC) in preventing preterm birth (gestation < 32 weeks).
• To assess TVCIC as a less invasive alternative to TACIC in women with a history of failed cervical cerclages.

Main Methods:

• A retrospective case series of 27 women with prior cervical cerclage failure who underwent elective TVCIC between 2015 and 2023.
• The TVCIC technique involves a posterior colpotomy, placement of a Mersilene tape encircling the cervix, and closure of the colpotomy.
• Fetal survival-to-discharge rate was analyzed as a secondary outcome.

Main Results:

• 96.3% of gestations (26/27) carried beyond 32 weeks of gestation.
• 77.8% of gestations (21/27) reached 37 weeks of gestation.
• The fetal survival-to-discharge rate was 96.3% (26/27), with no procedure-related maternal or neonatal complications.

Conclusions:

• Transvaginal cervicoisthmic cerclage (TVCIC) is a feasible and effective procedure for preventing preterm birth in women with previous cerclage failure.
• TVCIC shows promise as an alternative to the more invasive TACIC, warranting further investigation in larger studies.