Related Experiment Video
Updated: Mar 27, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Laparoscopic Cervical Cerclage Offers Greatest Benefit for Patients With Multiple Conizations or Significantly
Xia Li1,2,3, Jianmin Chen1,2,3, Jingyan Yang1,2,3
1Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Aim:
To evaluate the comparative effectiveness of laparoscopic cervical cerclage (LACC) versus transvaginal cervical cerclage (TVCC) in improving pregnancy outcomes for patients with a history of cervical conization, and to identify patient subgroups deriving the greatest benefit from LACC using causal inference methodology.
Methods:
This single-center retrospective cohort study included 179 patients with prior conization who underwent either TVCC (n = 110) or LACC (n = 69). Inverse probability of treatment weighting (IPTW) was employed to control for confounding and simulate a randomized trial scenario. The primary outcome was term delivery rate (≥ 37 weeks). Secondary outcomes included gestational age at delivery, neonatal birth weight, and late miscarriage rate. Treatment effect heterogeneity was analyzed via subgroup analysis and restricted cubic splines.
Results:
After IPTW adjustment, baseline covariates were well-balanced. LACC was associated with a significant absolute increase of 9.4% in the term delivery rate compared to TVCC (81.2% vs. 71.8%; ARD: +9.4%, 95% CI: 1.5 to 17.3; p = 0.020). LACC also demonstrated significant advantages in prolonging gestational age (MD: +0.8 weeks, p = 0.002), increasing neonatal birth weight (MD: +298 g, p = 0.002), and reducing late miscarriage (ARD: -5.6%, p = 0.045). A marked non-linear relationship was identified between pre-cerclage cervical length and LACC benefit, with maximum absolute benefit exceeding 30% when cervical length was < 2.0 cm.
Conclusion:
LACC is superior to TVCC in improving pregnancy outcomes for patients with a history of cervical conization, particularly for those with multiple prior conizations (≥ 2) or significantly shortened cervical length (< 2.0 cm). These findings support the use of LACC as a preferred, precision intervention for this high-benefit population.
