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Cervical length after cerclage: comparison between laparoscopic and vaginal approach

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

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.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, University Hospital of Berne and University of Berne, Inselspital, Effingerstrasse 102, 3010, Bern, Switzerland

    Daniele Bolla, Maria Luisa Gasparri, Michael D. Mueller, Andrea Papadia & Luigi Raio

  2. Department of Gynaecology, Obstetrics and Urology, “Sapienza” University of Rome, Rome, Italy

    Maria Luisa Gasparri

  3. Institute of Mechanical Systems, Swiss Federal Institute of Technology Zurich, Zurich, Switzerland

    Sabrina Badir

  4. Department of Obstetrics and Gynecology, University Hospital of Zurich, Zurich, Switzerland

    Michael Bajka

Authors
  1. Daniele Bolla
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  2. Maria Luisa Gasparri
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  3. Sabrina Badir
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  4. Michael Bajka
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  5. Michael D. Mueller
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  6. Andrea Papadia
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  7. Luigi Raio
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Corresponding author

Correspondence to Daniele Bolla.

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Conflict of interest

This study was not founded. The authors (Daniele Bolla, Maria Luisa Gasparri, Sabrina Badir, Michael Bajka, Michael D Mueller, Andrea Papadia, and Luigi Raio) declare to have no conflict of interest. Animal were not involved in the study. All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All patients signed an informed consent, prior to surgical procedures.

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Bolla, D., Gasparri, M.L., Badir, S. et al. Cervical length after cerclage: comparison between laparoscopic and vaginal approach. Arch Gynecol Obstet 295, 885–890 (2017). https://doi.org/10.1007/s00404-016-4285-5

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  • DOI: https://doi.org/10.1007/s00404-016-4285-5

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