Outcome after transabdominal cervicoisthmic cerclage.
OBJECTIVE
To estimate benefits and risks of transabdominal cervicoisthmic cerclage in women with cervical insufficiency in whom transvaginal cerclage is considered surgically unfeasible.


METHODS
This was an observational cohort study with historical controls of 101 pregnancies after transabdominal cervicoisthmic cerclage in 101 women with a classic history of cervical insufficiency and severe cervical defects precluding transvaginal cerclage.


RESULTS
Median gestational age at elective transabdominal cerclage (n = 95) was 14 (range 12-16) weeks and at emergency cerclage (n = 6) was 18 (range 17-22) weeks. Perioperative complications were blood loss 500 mL or more (n = 3) and rupture of membranes (n = 2). Patients were delivered by cesarean. Before cerclage 76% (95% confidence interval [CI] 70.2-81.1%) of births occurred before 32 weeks of gestation; total neonatal survival was 27.5% (95% CI 22.5-33.8%). After transabdominal cervicoisthmic cerclage 7% (95% CI 2.9-13.9%) of births took place before 32 weeks of gestation, and total neonatal survival was 93.5% (95% CI 85.5-96.6%).


CONCLUSIONS
In women with a classic history of cervical insufficiency and a traumatized cervix that precludes transvaginal cerclage, transabdominal cervicoisthmic cerclage is associated with successful outcome in the absence of procedure-related major complications.


METHODS
II-2.
Department of Obstetrics and Gynecology, Radboud University, Nijmegen Medical Centre, the Netherlands. f.lotgering@obgyn.umcn.nl
Frederik K
FK
Lotgering
Ingrid P M
IP
Gaugler-Senden
Sabine F
SF
Lotgering
Henk C S
HC
Wallenburg
D000026:Abortion, Habitual / Q000517:prevention & control*; D000328:Adult; D016022:Case-Control Studies; D023802:Cerclage, Cervical / Q000009:adverse effects / Q000379:methods*; D002585:Cesarean Section; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects / Q000379:methods; D008423:Maternal Age; D010298:Parity; D011183:Postoperative Complications / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000175:diagnosis / Q000601:surgery*