Laparoscopic transabdominal cerclage: preconception versus postconception placement.

Area of Science:

• Reproductive Medicine
• Maternal-Fetal Medicine
• Minimally Invasive Surgery

Background:

• Cervical insufficiency is a key cause of preterm birth and second-trimester pregnancy loss.
• Transabdominal cerclage is indicated for failed vaginal cerclage or anatomical challenges.
• Laparoscopic transabdominal cerclage offers a minimally invasive surgical option.

Purpose of the Study:

• To compare obstetric and surgical outcomes of laparoscopic transabdominal cerclage placed before versus during pregnancy.
• To assess the impact of cerclage timing on delivery at or beyond 34 weeks' gestation and neonatal survival.
• To evaluate secondary outcomes including gestational age, birth weight, and perioperative complications.

Main Methods:

• Retrospective cohort study of 69 patients undergoing laparoscopic transabdominal cerclage (2008-2023).
• Patients grouped by cerclage placement: before pregnancy (n=40) vs. during pregnancy (n=29).
• Primary outcomes: delivery ≥ 34 weeks' gestation and neonatal survival; secondary outcomes analyzed.

Main Results:

• No significant difference in delivery at ≥ 34 weeks (75% vs. 90%, p=.12) or neonatal survival (90% vs. 93%, p>.99).
• Median gestational age at delivery was similar (36.6 vs. 37.0 weeks, p=.02), with no clinically meaningful difference.
• Operative time, blood loss, and complications were comparable between groups; spontaneous preterm birth was higher in the preconception group.

Conclusions:

• Laparoscopic transabdominal cerclage before or during pregnancy yields similar gestational age at delivery and high neonatal survival.
• Findings support individualized counseling on cerclage timing.
• Limited study power restricts exclusion of clinically meaningful differences for rare outcomes.