Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon

Abstract

This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks’ gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.

Keywords::

• Cervical insufficiency
• pregnancy
• surgical complications
• transabdominal cervical cerclage

Acknowledgements

The authors thank Kathy Edie, Amberlee Hudson and Vicki Wasy for assisting with data collection and management, and Elizabeth McIntire, Tammy Chan, Rami Kilani and Candace McGregor for data collection and manuscript development.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.