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Pregnancy Outcomes of 512 Laparoscopic Transabdominal Cerclages: The Australian Cohort
1University of Melbourne, Melbourne, Australia (Dr Ades); Royal Women's Hospital, Melbourne, Australia (Dr Ades); Agora Specialist Center, Epworth Hospital, Melbourne, Victoria (Drs Ades and Mor).
Study Objective:
Cervical insufficiency is recognized as an important cause of obstetric morbidity and mortality, leading to midtrimester loss and preterm birth. Laparoscopic transabdominal cerclage is one of the proposed interventions to manage this condition. The study reports on a large series of pregnancies with laparoscopic transabdominal cerclage to assess its effectiveness.
Design:
This study evaluates laparoscopic transabdominal cerclage as a procedure to improve obstetric outcomes in patients diagnosed with cervical insufficiency. It is a retrospective observational study of consecutive patients who underwent laparoscopic transabdominal cerclage between August 2007 and July 2024.
Setting:
The research was conducted in Melbourne, Australia, in several public and private healthcare facilities.
Patients:
Eligible patients had a diagnosis of cervical insufficiency based on previous obstetric history and were referred for a laparoscopic transabdominal cerclage. The indications for a transabdominal cerclage were a previous failed vaginal procedure, previous oncologic surgery that removed large portions of the cervix, and multiple midtrimester pregnancy losses because of cervical insufficiency. All patients were entered on a database and were prospectively followed up during subsequent pregnancies. The primary outcome was neonatal survival, and the secondary outcome was delivery of an infant at ≥34 weeks' gestation.
Interventions:
Surgical laparoscopic transabdominal cerclage.
Measurement And Main Results:
During the period of the study, 512 patients underwent a laparoscopic transabdominal cerclage following a clinical diagnosis or concerns of cervical insufficiency. We present the outcomes of 524 pregnancy reports among 414 patients to date. Neonatal survival was 96.4%, with 85.7% of neonates delivered at >34 weeks gestation. Less than 0.5% of the laparoscopic transabdominal cerclage surgeries had surgical complications or documented morbidity.
Conclusions:
Laparoscopic transabdominal cerclage is a successful management option for patients with concerns of cervical insufficiency and complex obstetric and gynecological histories. This large cohort study shows positive neonatal outcomes and low surgical morbidity.
