Laparoscopic transabdominal cerclage: Outcomes of 121 pregnancies
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2018-12-01
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Australian and New Zealand Journal of Obstetrics and Gynaecology
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WILEY
Melbourne Authors
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Obstetrics and Gynaecology
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Journal Article
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Ades, A., Parghi, S. & Aref-Adib, M. (2018). Laparoscopic transabdominal cerclage: Outcomes of 121 pregnancies. Australian and New Zealand Journal of Obstetrics and Gynaecology, 58 (6), pp.606-611. https://doi.org/10.1111/ajo.12774.
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Abstract
BACKGROUND: Cervical insufficiency is a significant cause of morbidity and mortality. Cervical cerclage is one option in the management of cervical insufficiency. AIM: To evaluate obstetric outcomes following insertion of a pre-pregnancy laparoscopic transabdominal cerclage in women at high risk for pre-term labour and/or mid-trimester pregnancy loss. METHODS: A prospective observational study of consecutive women who underwent laparoscopic transabdominal cerclage from 2007 to 2017. Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix and were considered not suitable for a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated. RESULTS: During the study period, 225 women underwent laparoscopic transabdominal cerclage. We present the outcomes of 121 pregnancies resulting in 125 babies. The perinatal survival rate of viable pregnancies was 98.5% with a mean gestational age at delivery of 35.2 weeks; 79.7% of babies were delivered at ≥34.0 weeks gestation. CONCLUSION: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. For optimal success the procedure requires the correct surgical expertise, equipment and appropriate patient selection.