[Transvaginal cervico-isthmic cerclage using polypropylene tape: Surgical procedure and pregnancy outcome].
OBJECTIVE
To assess the efficacy of performing transvaginal cervicoisthmic cerclage (CIC) using synthetic tape in prevention of preterm labor in high-risk women.


METHODS
A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerclage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route.


RESULTS
The median age of the patients in this series was 33.2 years (range 25-41 years). No intra-operative complication occurred. The median operating time was 36.9 minutes (±4.1) (range 30-45 min). Cesarean delivery was systematically performed in all patients since the cerclage was considered to be definitive. Term birth rate was 57.5% (3% before CIC; p<0.0001). Pregnancy loss in the second trimester was 7.8% (66% before CIC; p<0.0001). Preterm birth rate was 23.1% (31% before CIC). Birth at less than 28 weeks occurred in only 1patients (3.7%) (10.7% before CIC). In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases (5%). Living birth rate was 80.7% (21% before CIC) and no neonatal death occurred (13% before CIC).


CONCLUSIONS
Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery.
Moez
M
Kdous
Monia
M
Ferchiou
Anis
A
Chaker
Feth
F
Zhioua
D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011126:Polypropylenes; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D012189:Retrospective Studies; D053832:Surgical Tape; D002581:Uterine Cervical Incompetence / Q000453:epidemiology / Q000601:surgery*
D011126:Polypropylenes