Outcome after transabdominal cervicoisthmic cerclage

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.