title: [Transabdominal cervico-isthmic cerclage in the management of cervical incompetence in high risk women].
abstract: OBJECTIVE
  Transabdominal cervico-isthmic cerclage is an alternative to vaginal route for patients with severe cervical incompetence. The purpose of this study is to describe our experience with this technique during pregnancy for high risk women.
  
  
  METHODS
  We performed a retrospective study including 12 transabdominal cerclages performed between 1988 and 2005. All patients had an history of repeated midtrimester fetal losses or preterm delivery, and 82% already had a prior failed transvaginal cerclage. Fourteen pregnancies were reported.
  
  
  RESULTS
  The median gestational age at cerclage placement was 14 weeks (range: 12 to 17). All patients underwent a caesarean section at a mean gestational age of 35 weeks gestation (range: 23 to 38 WG). The fetal survival rate was 93 compared to 17% before the cerclage. There were no significant perioperative or neonatal complications.
  
  
  CONCLUSIONS
  Transabdominal cervico-isthmic cerclage remains a reliable technique for the management of cervical incompetence after a prior failed transvaginal cerclage when vaginal access is difficult. Laparoscopic approach is under development.
authors.affiliation: Service de Gynécologie Obstétrique, CHU Paule-de-Viguier, 330, avenue de Grande-Bretagne, TSA 70034, 31059 Toulouse cedex 09, France.
authors.forename: A
authors.initials: A
authors.lastname: Gesson-Paute
authors.forename: A
authors.initials: A
authors.lastname: Berrebi
authors.forename: O
authors.initials: O
authors.lastname: Parant
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D005865:Gestational Age; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000517:prevention & control*; D012189:Retrospective Studies