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Published on: September 12, 2025
698
Total cervical occlusion: A solution after cervico-isthmic cerclage failure
Déborah Couet1,2, Anne-Gaëlle Pourcelot1,2, Claire Szmulevicz1,2
1Department of Gynecology and Obstetrics, CHU de Bicêtre, AP-HP, DMU2, Le Kremlin-Bicêtre, France.
Summary
Total cervical occlusion (TCO) effectively prolongs pregnancy in women with failed cervico-isthmic cerclage. This procedure offers a viable option for preventing preterm birth when standard methods are unsuccessful.
Area of Science:
- Maternal-Fetal Medicine
- Surgical Obstetrics
- Reproductive Medicine
Background:
- Spontaneous preterm birth is often linked to cervical incompetence.
- Cervical cerclage is the standard treatment for mid-trimester losses and preterm delivery.
- Cervico-isthmic cerclage is an option when initial cerclage fails, offering high neonatal survival rates.
Purpose of the Study:
- To evaluate the efficacy of Total Cervical Occlusion (TCO) using the Saling technique.
- To assess TCO as a treatment option for cases where cervico-isthmic cerclage has previously failed.
Main Methods:
- A single-center study involving five women who underwent TCO after the first trimester.
- Surgical technique and outcomes were analyzed between 2009 and 2023.
- All participants had a history of failed cervico-isthmic cerclage.
Main Results:
- Five women underwent TCO, three for recurrent late miscarriage and two for threatened late miscarriage.
- Pregnancy was successfully prolonged for all five women.
- The mean gestational age at delivery was 32.5 weeks, with an average prolongation of 11.7 weeks.
Conclusions:
- Total Cervical Occlusion (TCO) is an effective method for prolonging pregnancy in cases of failed cervico-isthmic cerclage.
- This technique provides a potential solution for preventing preterm birth when other cerclage methods are unsuccessful.
