Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study

• Published in: American journal of obstetrics and gynecology Vol. 207; no. 4; pp. 273.e1 - 273.e12
• Main Authors: Burger, Nicole B., MD, Einarsson, Jon I., MD, MPH, Brölmann, Henricus A.M., MD, Vree, Florentien E.M., MD, McElrath, Thomas F., MD, PhD, Huirne, Judith A.F., MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.10.2012; Elsevier
• Subjects: abdominal cerclage; Adult; Biological and medical sciences; Cerclage, Cervical; cervical insufficiency; Cervix Uteri - surgery; Cohort Studies; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Medical sciences; Obstetric Labor, Premature - prevention & control; Obstetric Labor, Premature - surgery; Obstetrics and Gynecology; preconceptional laparoscopic abdominal cerclage; Pregnancy; Premature Birth - prevention & control; Premature Birth - surgery; Retrospective Studies; Secondary Prevention; Treatment Outcome; preconceptional laparoscopic abdominal cerclage; abdominal cerclage; cervical insufficiency; Surgical cerclage; Cohort study; Multicenter study; Gynecology; Laparoscopy; Endoscopy; Obstetrics; Abdomen
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2012.07.030

Objective The purpose of this study was to evaluate the effectiveness of laparoscopic abdominal cerclage placement in the prevention of recurrent preterm birth. Study Design We conducted a multicenter cohort study with retrospective Dutch (32 patients) and Boston (34 patients) cohorts who had undergone preconceptional laparoscopic abdominal cerclage placement. Eligible patients had at least 1 second/third trimester fetal loss or delivered at <34 weeks of gestation because of cervical insufficiency and/or a short or absent cervix. Primary outcome was delivery of an infant at ≥34 weeks of gestation with neonatal survival. Secondary outcome measures included surgical and pregnancy outcomes and patients' satisfaction (Dutch cohort). Results Surgical outcomes of 66 patients were excellent, with 3 minor complications. After preconceptional laparoscopic abdominal cerclage, 35 pregnancies were evaluated. Twenty-five patients (71.4%) delivered at ≥34 weeks of gestation; 3 patients (8.6%) experienced a second-trimester fetal loss. The total fetal survival rate was 90.0%. Conclusion Preconceptional laparoscopic abdominal cerclage shows encouraging and favorable perinatal outcomes in patients with a poor obstetric history.