title: Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage.
abstract: OBJECTIVE
  Our purpose was to compare the incidence of preterm birth after a prior failed vaginal cerclage in patients who had a subsequent transabdominal or a transvaginal cerclage.
  
  
  METHODS
  We conducted a retrospective cohort study of singleton pregnancies in women who had undergone (9-14 weeks) either a transabdominal or a transvaginal prophylactic cerclage after >/=1 prior failed transvaginal cerclage. Prior failed transvaginal cerclage was defined as a preterm birth at <33 weeks' gestation in the immediate prior pregnancy despite a transvaginal cerclage. All transabdominal cerclage procedures were performed by a single attending physician (George Davis, DO). Patients with a cervix too short for transvaginal cerclage placement, placenta previa, or major fetal anomalies were excluded. Primary outcome was preterm birth at <35 weeks' gestation.
  
  
  RESULTS
  Forty transabdominal and 24 transvaginal cerclage pregnancies were analyzed. These 2 groups were similar in race and payer status but differed in age (34.0 +/- 4.2 vs 31.3 +/- 4.6 years, respectively; P =.01). The transabdominal cerclage group had more prior failed cerclage procedures per patient (1.8 +/- 1.0 vs 1.1 +/- 0.3; P =.02) and more prior 14- to 24-week spontaneous abortions per patient (2.4 +/- 1.3 vs 1.5 +/- 1.0; P =.02) than the transvaginal cerclage group. Preterm delivery at both <35 and <33 weeks' gestation was less common in the transabdominal cerclage group (18% vs 42%, P =.04; 10% vs 38%, P =.01; respectively) than in the transvaginal cerclage group. Gestational age at delivery was 36. 3 +/- 4.1 weeks in the transabdominal cerclage group and 32.8 +/- 8. 6 weeks in the transvaginal cerclage group (P =.03). Preterm premature rupture of membranes also occurred less often in the transabdominal cerclage group than in the transvaginal cerclage group (8% vs 29%, P =.03).
  
  
  CONCLUSIONS
  In patients with a prior failed transvaginal cerclage, transabdominal cerclage is associated with a lower incidence of preterm delivery and preterm premature rupture of membranes in comparison with transvaginal cerclage.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: G
authors.initials: G
authors.lastname: Davis
authors.forename: V
authors.initials: V
authors.lastname: Berghella
authors.forename: M
authors.initials: M
authors.lastname: Talucci
authors.forename: R J
authors.initials: RJ
authors.lastname: Wapner
mesh_terms: D000005:Abdomen; D000328:Adult; D002584:Cervix Uteri / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007752:Obstetric Labor, Premature / Q000453:epidemiology / Q000517:prevention & control; D013513:Obstetric Surgical Procedures; D011247:Pregnancy; D011256:Pregnancy Outcome; D019233:Retreatment; D012189:Retrospective Studies; D013536:Suture Techniques; D017211:Treatment Failure; D014621:Vagina