Updates on Laparoscopic Cervical Cerclage: Obstetric Outcomes and Surgical Techniques

Abstract

Aim: Preterm birth is a worldwide health problem. After unsuccessful transvaginal cerclage, the transabdominal isthmo-cervical cerclage can be indicated. A laparoscopic approach has been described. Methods: A search was performed including the combination of: “((cerclage) AND (laparoscopy)) AND (pregnancy)”. A systematic review was performed to compare indications, outcomes, techniques, and safety. Results & discussion: 42 articles were found through database search. 30 articles were included for review. By reviewing the literature, the transabdominal cervico-isthmic laparoscopic cerclage is highly effective in selected patients with a history of refractory cervical insufficiency. This technique has a high neonatal survival rate when placed in preconceptional or post conceptional patients. Moreover, laparoscopic cervical cerclage is a safe procedure when laparoscopic expertise is present.

Plain Language Summary

A transvaginal cerclage is a procedure that places a stitch or tape within the cervix to mechanically close the cervix to prevent it from opening too early during pregnancy. However, if transvaginal cerclage fails, doctors may recommend a transabdominal isthmo-cervical cerclage using a laparoscopic approach. A systematic review analyzed 30 articles to compare the reasons for surgery, outcomes, techniques, and safety. The review suggests that this procedure is highly effective for certain patients with a history of refractory cervical insufficiency. It appears to be a safe technique with a high rate of survival for newborns and rare complications.

Keywords:

• cervical cerclage
• laparoscopy
• pregnancy

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.