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  • Title: Feasibility and clinical effects of laparoscopic abdominal cerclage: an observational study.
    Author: Riiskjaer M, Petersen OB, Uldbjerg N, Hvidman L, Helmig RB, Forman A.
    Journal: Acta Obstet Gynecol Scand; 2012 Nov; 91(11):1314-8. PubMed ID: 22974182.
    Abstract:
    OBJECTIVE: To evaluate the effect of laparoscopic abdominal cerclage performed as an interval procedure in non-pregnant women at high risk of second trimester spontaneous abortion and early preterm birth. DESIGN: Observational study. SAMPLE: Fifty-two consecutive patients at high risk of preterm birth. SETTING: Department of Obstetrics and Gynecology, Aarhus University Hospital. METHODS: Patients were registered prospectively. Indications for surgery included classical cervical insufficiency, preterm premature rupture of membranes (PPROM) or two conizations/cervical amputation. Outcome of subsequent pregnancies was registered. MAIN OUTCOME MEASURES: Gestational age in subsequent pregnancies. RESULTS: No operative or postoperative complications were observed. A total of 45 pregnancies were registered during the observation period. Among 36 pregnancies lasting beyond the 16th week of gestation, 30 women (83.3%) gave birth by cesarean section after 36 weeks of gestation and the overall mean gestational age was 37.4 weeks compared with a mean gestational age of 25.2 weeks of the pregnancies prior to the cerclage. The cesarean sections were uncomplicated in all but one patient, where a re-laparotomy was needed six hours later due to atonic postpartum hemorrhage without evident bleeding through the cervix. CONCLUSION: Laparoscopic abdominal cerclage is a feasible and safe procedure. Obstetrical outcomes are encouraging but prospective studies are needed to define the effectiveness of the laparoscopic cerclage compared with the traditional transvaginal approach.
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