Quality-of-life and late effects after transabdominal cerclage: A nationwide matched cohort study

A transabdominal cerclage is inserted to prevent recurrent midtrimester loss and spontaneous preterm birth. The transabdominal cerclage often remains as a permanent foreign body for years. Synthetic materials within the abdomen, cesarean birth, and prior adverse pregnancy outcomes have each been associated with long-term complications or poorer health-related quality-of-life. However, the long-term effects of a permanent transabdominal cerclage have not been investigated. We aimed to evaluate patient-reported late effects and health-related quality-of-life in Danish women who underwent transabdominal cerclage between 2004 and 2025.

In this nationwide cohort study, women with a transabdominal cerclage were matched in a 1:1:1 ratio to two comparison groups: (1)women without transabdominal cerclage who had a cesarean birth, and (2)women without transabdominal cerclage who had a non-instrumental vaginal birth and no prior cesarean birth. Participants completed validated questionnaires assessing quality-of-life, anxiety and depression, bladder discomfort, pelvic pain and sexual health. The primary outcome was the General Health scale in SF-36. Domain- and total scale scores were compared between the groups using multiple linear regression. The study was pre-registered on clinicaltrials.gov (NCT06875401).

Two hundred three women with a transabdominal cerclage, 90 with a cesarean section, and 98 with a vaginal birth participated. The mean General Health score did not differ between groups by a predefined minimally important difference of 10 points. Adjusted mean differences were - 4.0 points (95% CI -9.5-1.4) for women with cesarean birth and -0.6 (95% -CI-6.2-4.9) for women with vaginal birth in comparison to the transabdominal cerclage group. Mental health, bladder discomfort, pelvic pain, and sexual health symptom burdens were similar between groups. Response rates were higher in the transabdominal cerclage group, which may have introduced selection bias. Cerclage-related complications leading to suture removal after completed pregnancies were rare (3/203 women, 1.5%). Quality-of-life scores tended to be higher with longer time since cerclage procedure.

Permanent transabominal cerclage was not associated with poorer self-reported general health compared with women without transabominal cerclage, regardless of mode of birth. These findings support that a permanent transabominal cerclage does not appear to have long-term negative health effects.