Laparoscopic Abdominal Cerclage is an Excellent Option for Women with Recurrent Fetal Loss

Preconceptual laparoscopic abdominal cerclage, which is permanent, is associated with favorable perinatal outcomes in patients with a poor obstetric history, concludes a new study.¹

Placement of a cervical cerclage has been the management strategy to help reinforce the cervix in women who have had multiple pregnancy losses because of an insufficient cervix. Traditionally, this cervical stitch has been placed transvaginally but, in 1965, a transabdominal approach was described.² Although a cerclage placed transvaginally has been effective for many patients, a transabdominal approach allows for the cerclage to be placed more proximal to the internal os, allows for a more secure stitch, eliminates risk of foreign body material from entering the vagina, and can be used in subsequent pregnancies.

According to the literature, the success rate of transabdominal cerclage is high, with some estimates of neonatal survival rates exceeding 90%.^3-5 However, the surgery as originally described required a laparotomy, which carried the risk of increased maternal morbidity.³ Recent surgical advances have made this procedure possible using laparoscopy, which Burger et al¹ evaluated to determine the effectiveness when placed before conception in the prevention of recurrent preterm birth.

Eligible patients, comprising cohorts in The Netherlands (n=32) and in Boston (n=34), had at least 1 fetal loss in the second or third trimester or had a preterm delivery at less than 34 weeks’ gestation because of a short or absent cervix or cervical insufficiency. All patients had undergone abdominal cerclage before conception. The primary outcome was a surviving neonate delivered at or after 34 weeks’ gestation. Surgical and pregnancy outcomes were included as secondary outcome measures.

The surgical outcomes of all 66 patients, barring 3 minor complications, were excellent, according to the study authors. Of the 35 pregnancies evaluated, 25 (71.4%) resulted in delivery at or after 34 weeks’ gestations, with 90% of the neonates surviving. A second trimester fetal loss occurred in 3 pregnancies (8.6%). Based on these outcomes, the authors believe that laparoscopic abdominal cerclage before conception is an excellent option for women with a poor obstetric history.

Pertinent Points:
- Preconception laparoscopic transabdominal cerclage is an effective option for preventing repeated pregnancy loss in certain patients.
- Women with a shortened or absent cervix or those in whom previous transvaginal cerclage failed are the best candidates for transabdominal cerclage.