Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors

Abstract

This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.

Updates on Laparoscopic Cervical Cerclage: Obstetric Outcomes and Surgical Techniques

“…The largest case series was reported by Chung et al who underwent a retrospective observational cohort study of patients operated on modified laparoscopic transabdominal cervical cerclage from 2003 to 2018 with a sample size of 299 pregnant women with a mean gestational age of 12.5 weeks [ 19 ]. There were 176 of 205 successful deliveries via cesarean section with a fetal survival rate of 85.9%.…”

“…Ades et al [ 9 ] did not report any serious complications in their case series where cerclage was placed in 19 pregnant women before 11 weeks of gestation. Chung et al [ 19 ] published recently the outcomes of the modified laparoscopic cervical cerclage when placed in gravid women with a mean gestational age of 12.5 weeks with the largest sample size (299). The operative complications rate was 0%.…”

“…On the other hand, over the 205 pregnancies followed up after their post conceptional modified laparoscopic cerclage in Chung et al study, 176 (85.9%) delivered successfully live births. 60 of 205 patients (29.2%) delivered before 37 weeks [ 19 ]. Furthermore, the neonatal survival rate was 93.8%, with mean gestational age at delivery 36.9 in Clark et al study [ 20 ], where 124 preconceptional women and 13 pregnant women, with a history of recurrent pregnancy loss underwent laparoscopic cervical cerclage.…”

Case Report of a 31-Year-Old Woman with COVID-19 and Chorioamnionitis at 18 Weeks of Gestation with a Twin Pregnancy and an Abdominal Cerclage for Cervical Incompetence Removed by Posterior Colpotomy Approach

“…Recurrent mid-trimester loss and spontaneous preterm birth are complications encountered in 1% of couples that are seeking fertility [ 1 ]. Major causes of these complications include cervical incompetence and anatomical deformities, whether congenital or due to surgeries on the cervix, such as radical trachelectomy or conization procedures [ 2 ].…”

Special Issue Recurrent Pregnancy Loss: Etiology, Diagnosis, and Therapy

“…A subset of RPL patients experience second trimester loss or preterm birth under a clinical picture of painless cervical dilatation or rupture of the membranes, traditionally called cervical insufficiency. Vaginal cerclage often fails in these cases, but a cohort study by Chung et al [5], where 21.1% of the included patients had suffered three or more previous pregnancy losses, suggest that modified laparoscopic cervico-isthmic cerclage can increase the fetal survival rate. However, randomized trials are still needed to document the real benefits of this procedure.…”