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Obstetrics & Gynecology 2006;107:779-784
© 2006 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Outcome After Transabdominal Cervicoisthmic Cerclage

Frederik K. Lotgering, MD, PhD1, Ingrid P.M. Gaugler-Senden, MD2, Sabine F. Lotgering2 and Henk C. S. Wallenburg, MD, PhD2

From the Departments of Obstetrics and Gynecology, 1Radboud University Nijmegen Medical Centre, Nijmegen; and 2Erasmus Medical Center, Rotterdam, the Netherlands.

OBJECTIVE: To estimate benefits and risks of transabdominal cervicoisthmic cerclage in women with cervical insufficiency in whom transvaginal cerclage is considered surgically unfeasible.

METHODS: This was an observational cohort study with historical controls of 101 pregnancies after transabdominal cervicoisthmic cerclage in 101 women with a classic history of cervical insufficiency and severe cervical defects precluding transvaginal cerclage.

RESULTS: Median gestational age at elective transabdominal cerclage (n = 95) was 14 (range 12–16) weeks and at emergency cerclage (n = 6) was 18 (range 17–22) weeks. Perioperative complications were blood loss 500 mL or more (n = 3) and rupture of membranes (n = 2). Patients were delivered by cesarean. Before cerclage 76% (95% confidence interval [CI] 70.2–81.1%) of births occurred before 32 weeks of gestation; total neonatal survival was 27.5% (95% CI 22.5–33.8%). After transabdominal cervicoisthmic cerclage 7% (95% CI 2.9–13.9%) of births took place before 32 weeks of gestation, and total neonatal survival was 93.5% (95% CI 85.5–96.6%).

CONCLUSION: In women with a classic history of cervical insufficiency and a traumatized cervix that precludes transvaginal cerclage, transabdominal cervicoisthmic cerclage is associated with successful outcome in the absence of procedure-related major complications.

LEVEL OF EVIDENCE: II-2






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