title: Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy.
abstract: The objective of this study was to evaluate the efficacy of abdominal cerclage via laparoscopy vs laparotomy and before vs after conception. We evaluated 16 studies of abdominal cerclage involving a total of 678 cases published between 1990 and 2013. We estimated the effect of laparotomy over laparoscopy and the effect of preconceptional over postconceptional cerclage using a generalized linear model by treating the success rates (third-trimester delivery and live birth) as dependent variables and laparotomy and preconceptional as independent factors. The results demonstrated that there was no difference in the rates of third-trimester delivery and live birth rates between preconceptional abdominal cerclage via laparoscopy (71.4%-83.3% and 90%-100%, respectively) or laparotomy (97.3%-100% and 100%, respectively). For postconceptional cerclage, the rates of third-trimester delivery and live birth via laparoscopy were 70% and 70% to 100%, respectively, and via laparotomy were 77.4% to 99.5% and 85.2% to 100%, respectively. There was no difference in the live birth rates when abdominal cerclage was performed before or during pregnancy. We concluded that the rates of third-trimester delivery and live birth after abdominal cerclage via laparoscopy are high and comparable to those via laparotomy. The efficacy of the procedure performed either before or during pregnancy is similar. Abdominal cerclage performed before conception is more practical than after conception. With the inherent advantages of laparoscopy over laparotomy, abdominal cerclage performed via laparoscopy is preferable, in particular when performed in non-pregnant women.
authors.affiliation: Department of Obstetrics and Gynecology, and the Division of Epidemiology, McGill University, Montreal, Quebec, Canada. Electronic address: togas.tulandi@mcgill.ca.
authors.forename: Togas
authors.initials: T
authors.lastname: Tulandi
authors.affiliation: Department of Obstetrics and Gynecology, and the Division of Epidemiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Nadin
authors.initials: N
authors.lastname: Alghanaim
authors.affiliation: Department of Obstetrics and Gynecology, and the Division of Epidemiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Ghaidaa
authors.initials: G
authors.lastname: Hakeem
authors.affiliation: Department of Obstetrics and Gynecology, and the Division of Epidemiology, McGill University, Montreal, Quebec, Canada.
authors.forename: Xianming
authors.initials: X
authors.lastname: Tan
mesh_terms: D000005:Abdomen / Q000601:surgery; D023802:Cerclage, Cervical / Q000379:methods* / Q000706:statistics & numerical data; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000706:statistics & numerical data; D007813:Laparotomy / Q000379:methods / Q000706:statistics & numerical data; D050498:Live Birth; D016742:Preconception Care / Q000379:methods / Q000706:statistics & numerical data; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011295:Prenatal Care / Q000379:methods / Q000706:statistics & numerical data; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000453:epidemiology / Q000601:surgery*
keywords: Abdominal cerclage; Cervical cerclage; Cervicoisthmic cerclage; Laparoscopic cerclage; Preconceptional cerclage; Transabdominal cerclage