Prediction of Outcome for Transabdominal Cerclage in Women with Cervical Insufficiency

Abstract

We investigated pregnancy outcome following transabdominal cerclage (TAC) in women with cervical insufficiency (CI) and explored parameters for predicting pregnancy outcomes following TAC. In this retrospective cohort study, we included 161 women with TAC. We considered demographic, obstetric, and gynecologic histories, pre- and postoperative cervical length (CL), and CL at 20–24 weeks as parameters for predicting outcomes following TAC. Univariate and multivariate analyses were used to identify risk factors for predicting delivery before 34 weeks after TAC. 182 pregnancies occurred after TAC, and 290 pregnancies prior to TAC were identified. The rate of delivery <34 weeks significantly decreased following TAC (5% versus 82%, P < 0.001). Univariate analysis demonstrated that a short CL (<25 mm) at 20–24 weeks and adenomyosis were associated with delivery at <34 weeks' gestation following TAC (P = 0.015 and P = 0.005, resp.). However, multivariate analysis demonstrated that only a short CL (<25 mm) at 20–24 weeks was a significant predictor (P = 0.005). TAC is an efficacious procedure that prolongs pregnancy in women with CI. A short CL at 20–24 weeks may predict the delivery at <34 weeks' gestation following TAC.

Transabdominal Cerclage Placement in a Gravid Patient at Week 22 of Gestation Period: A Case Report and Review of the Literature

“…We proceeded to emergency TAC placement, as it was the only option to prolong the pregnancy. Despite the complete cervical dilation in our patient, which, is considered an adverse prognostic factor for the success of the cerclage and for full term labor [>34 th week] [4], delivery began at 34+0 week.…”

“…TAC is not routinely performed, as it is an extremely difficult procedure from a technical point of view and it is associated with higher morbidity rates than TVC [11]; however, it may be the only option in a small number of patients in whom TVC cannot be performed. TVC is contraindicated in the presence of an extremely short cervix [congenital or acquired], in cases of distorted cervical anatomy [8] including an amputated cervix due to trachelectomy or conization, a scarred cervix due to previous unsuccessful TVC or previous obstetrical trauma [4] and in cases of advanced [second trimester] gestational age. In our case, TAC was the only feasible solution, because of the complete cervical dilation and the advanced gestational age, which rendered TVC impossible.…”

“…In the literature, the reported survival rates range between 60% and 96% [13][14][15]. Song et al [4] reported a high fetal survival rate equal to 96% and higher rates of delivery at >34 weeks of gestation [95%] in TAC pregnancies; furthermore, the authors suggested that the successful outcomes in TAC cases may be attributed to the position of the cerclage band and the knot which are placed higher compared to TVC placement. Therefore, TAC technique may potentially prevent an inflammatory reaction, resulting in prolongation of the pregnancy.…”

“…Cervical length is another predictive factor of successful TAC [4]; the shorter the cervical length is at 20-24 weeks of pregnancy, the higher the possibility of preterm labor before 34 weeks, after TAC. In our case, despite the complete dilation of the cervix, TAC placement was successfully performed without further complications and the labor began at week 34 of gestation.…”

“…Despite the absence of uterine activity, CI may result to miscarriage or preterm labor [1]. The incidence of CI is estimated less than 1% of all pregnancies [2]; however, it seems to be responsible for about 8% of the second trimester miscarriages [3] and is, therefore, considered as one of the leading causes of preterm labor and neonatal morbidity and mortality [4].…”