title: Cervical length after cerclage: comparison between laparoscopic and vaginal approach.
abstract: OBJECTIVE
  The aim of our study was to investigate the sonographic changes of the cervical length during pregnancy after the placement of a transvaginal cervical cerclage (TVC) or a laparoscopic abdominal cerclage (LAC) in patients with cervical insufficiency (CI).
  
  
  METHODS
  Between January 2008 and March 2015, a retrospective analysis of all women undergoing a prophylactic laparoscopic (LAC group) or transvaginal (TVC group) cerclage due to cervical insufficiency was conducted. Nonparametric variables were analysed with the Mann-Whitney (U) test, and categorical-type outcomes were analysed with the Fisher's exact test. A p value <0.05 was considered as significant. Data analysis was performed using Prism 5 for Mac OS X.
  
  
  RESULTS
  Thirty-eight patients were included. Of these, 18 and 20 underwent an LAC and a TVC, respectively. Mean gestational age at surgery in the LAC and TVC groups was 11.4 ± 1.6 and 17 ± 3 weeks, respectively (p < 0.05). The cervical length prior to surgery was similar among the two groups. After cerclage placement, the distance between the tape and the external cervical os differed significantly between the two groups (LAC: 31.5 ± 8.8 mm vs TVC: 13.5 ± 4.9 mm; p < 0.0001) (Fig. 1). During pregnancy, the cervical length in the TVC group showed a significant shortening (from 26.6 ± 7 mm before surgery to 13.2 ± 7 mm at 33 weeks; p < 0.0001), while in the LAC group, the cervical length remained unchanged.
  
  
  CONCLUSIONS
  In patients with CI, LAC is associated with a better preservation of the cervical length throughout pregnancy as compared to TVC.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland. daniele.bolla@insel.ch.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bolla
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland.|Department of Gynaecology, Obstetrics and Urology, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Gasparri
authors.affiliation: Institute of Mechanical Systems, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Badir
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland.
authors.forename: Michael
authors.initials: M
authors.lastname: Bajka
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Mueller
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland.
authors.forename: Andrea
authors.initials: A
authors.lastname: Papadia
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Raio
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000379:methods*; D002584:Cervix Uteri / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005865:Gestational Age; D006801:Humans; D010535:Laparoscopy; D011247:Pregnancy; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000473:pathology / Q000601:surgery
keywords: Cervical insufficiency; Laparoscopic abdominal cerclage; Prophylactic cerclage; Transvaginal cerclage