Fighting preterm birth with the scalpel: lessons from a decade of total cervical occlusion

Preterm birth remains a leading cause of neonatal morbidity and mortality worldwide. Despite medical advances, effective prevention remains challenging. Surgical interventions like total cervix occlusion (TCO) show promise in high-risk groups.

This was a retrospective study including patients with singleton pregnancies who had undergone Saling's TCO at the Medical School of Hannover from 2011 to 2021. Data on maternal characteristics, obstetric history, intervention details, and outcomes were collected. Patients were stratified into two groups: classic Saling indication (≥2 late miscarriages or preterm births <32 weeks) and extended indication (1 such event). Primary outcomes were live birth and preterm birth after 28 + 0 weeks.

The analysis is based on a sample of 99 pregnant women, pregnancy and outcome data was available of 67 patients. The median delivery time was 36 weeks. 92.5 % of the neonates were born alive, with 88.1 % of these births occurring after the 28th week of gestation. Patients with extended indication showed longer gestation than those with classic indication. Maternal age, BMI, and conception mode had no impact. Higher parity increased chances of live birth, prior preterm birth lowered it. Previous late abortions raised the risk of delivery before 28 weeks.

TCO may prolong gestation and improve outcomes, independent of maternal factors. Women with extended indications appear to benefit as well. Given the lack of prospective data and varied international practices, further randomized, multicenter trials are urgently needed to better define indications and assess efficacy.