title: Preconceptional laparoscopic abdominal cerclage: a multicenter cohort study.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the effectiveness of laparoscopic abdominal cerclage placement in the prevention of recurrent preterm birth.
  
  
  METHODS
  We conducted a multicenter cohort study with retrospective Dutch (32 patients) and Boston (34 patients) cohorts who had undergone preconceptional laparoscopic abdominal cerclage placement. Eligible patients had at least 1 second/third trimester fetal loss or delivered at <34 weeks of gestation because of cervical insufficiency and/or a short or absent cervix. Primary outcome was delivery of an infant at ≥ 34 weeks of gestation with neonatal survival. Secondary outcome measures included surgical and pregnancy outcomes and patients' satisfaction (Dutch cohort).
  
  
  RESULTS
  Surgical outcomes of 66 patients were excellent, with 3 minor complications. After preconceptional laparoscopic abdominal cerclage, 35 pregnancies were evaluated. Twenty-five patients (71.4%) delivered at ≥ 34 weeks of gestation; 3 patients (8.6%) experienced a second-trimester fetal loss. The total fetal survival rate was 90.0%.
  
  
  CONCLUSIONS
  Preconceptional laparoscopic abdominal cerclage shows encouraging and favorable perinatal outcomes in patients with a poor obstetric history.
authors.affiliation: Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands. n.burger@vumc.nl
authors.forename: Nicole B
authors.initials: NB
authors.lastname: Burger
authors.forename: Jon I
authors.initials: JI
authors.lastname: Einarsson
authors.forename: Henricus A M
authors.initials: HA
authors.lastname: Brölmann
authors.forename: Florentien E M
authors.initials: FE
authors.lastname: Vree
authors.forename: Thomas F
authors.initials: TF
authors.lastname: McElrath
authors.forename: Judith A F
authors.initials: JA
authors.lastname: Huirne
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical; D002584:Cervix Uteri / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D007752:Obstetric Labor, Premature / Q000517:prevention & control* / Q000601:surgery; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D016896:Treatment Outcome