Abdominal cerclage for the treatment of recurrent cervical insufficiency: laparoscopy or laparotomy?
OBJECTIVE
The purpose of this study was to compare the efficacy of traditional abdominal cerclage (AC) with laparoscopic cerclage (LC).


METHODS
Eligible women had at least 1 second trimester pregnancy loss due to cervical insufficiency, and had undergone at least 1 failed transvaginal cerclage. A prospective cohort of patients undergoing LC was compared with a historical control group of patients who had AC. A successful primary outcome was defined as delivery of a viable infant with neonatal survival.


RESULTS
We were able to evaluate 19 pregnancies following unique abdominal cerclage placement, 12 laparoscopic and 7 at the time of laparotomy. Nine of 12 (75%) undergoing LC and 5 of 7 (71%) pregnancies undergoing AC successfully delivered a viable infant (P = .63). LC during pregnancy was successful in 4 of 5 (80%) cases as compared to 3 of 5 (60%) cases with AC during pregnancy (P = 1.0).


CONCLUSIONS
Operative laparoscopy is a safe and effective alternative to laparotomy for the placement of abdominal cerclage.
Carter
James F
JF
Department of Obstetrics and Gynecology, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. caterja@musc.edu
Soper
David E
DE
Goetzl
Laura M
LM
Van Dorsten
J Peter
JP
D000005:Abdomen; D000026:Abortion, Habitual / Q000209:etiology; D000328:Adult; D000556:Ambulatory Surgical Procedures; D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D002581:Uterine Cervical Incompetence / Q000601:surgery; D055815:Young Adult