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The comparative analysis of laparoscopic or transvaginal cerclage in pregnancies with cervical insufficiency: a retrospective cohort study

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

Abstract

Objective

To evaluate the efficacy and safety of prophylactic cervical cerclage by laparoscopy in pregnant women versus transvaginal way.

Design

Retrospective, monocentric cohort study was performed.

Setting

The First Affiliated Hospital of Sun Yat-sen University.

Patients

Cases with cervical insufficiency (defined by previous history of painless second or early third trimester pregnancy loss/losses) were selected.

Interventions

Laparoscopic or transvaginal cerclage were conducted. The maternal information and the neonatal data were collected and compared. The pregnancy outcomes including the incidence of full-term labor and gestational weeks at delivery were defined as the primary outcomes. Neonatal survival and birth weight, neonatal complications were evaluated as the secondary outcomes.

Measurements and main results

Totally 36 twin pregnant cases and 82 singleton pregnant cases were managed with cerclage, either trans-laparoscopy (totally 78 cases) or transvaginal (totally 40 cases). Demographic characteristics showed no significant differences. Cases in laparoscopic group had a prolonged gestational age at delivery (36.43 ± 0.93 weeks and 33.60 ± 2.78 weeks, respectively, P < 0.001), a higher incidence of full-term labor (60.26% vs 42.50%, P = 0.05) with no significant difference of perinatal mortality (P = 0.661). Meanwhile, higher incidence of normal birth weight infants (88.46% vs 67.50%, P = 0.007) was shown in laparoscopic group with no more complications such as the cases of neonatal with Apgar < 7 (P = 0.296), and the incidence of NICU admission (P = 0.237). Besides, LTC showed good efficiency on VTC in the incidence of full-term labor: HR 0.24 (95% CI 0.070–0.85), P < 0.001. While LSC showed the similar efficiency on VSC: HR 0.734 (95% CI 0.36–1.49), P = 0.857, showing that cases with twin pregnancy may benefit more from laparoscopic cerclage.

Conclusions

The comparative effect between laparoscopic and transvaginal cerclage in pregnant women showed that laparoscopic cerclage may be a relatively effective and safety prophylactic way for cervical insufficiency. This would be an acceptable and safe replace for traditional transvaginal cervical cerclage.

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References

  1. Slattery MM, Morrison JJ (2002) Preterm delivery. Lancet 360(9344):1489–1497

    Article  PubMed  Google Scholar 

  2. American College of O and Gynecologists (2014) ACOG Practice Bulletin No. 142: Cerclage for the management of cervical insufficiency. Obstet Gynecol 123(2 Pt 1):372–379

  3. Scibetta JJ, Sanko SR, Phipps WR (1998) Laparoscopic transabdominal cervicoisthmic cerclage. Fertil Steril 69(1):161–163

    Article  CAS  PubMed  Google Scholar 

  4. Witt MU, Joy SD, Clark J, Herring A, Bowes WA, Thorp JM (2009) Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol 201(1):105, e101–e104

    Article  Google Scholar 

  5. Chen Y, Liu H, Gu J, Yao S (2015) Therapeutic effect and safety of laparoscopic cervical cerclage for treatment of cervical insufficiency in first trimester or non-pregnant phase. Int J Clin Exp Med 8(5):7710–7718

    PubMed  PubMed Central  Google Scholar 

  6. Berghella V, Odibo AO, To MS, Rust OA, Althuisius SM (2005) Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol 106(1):181–189

    Article  PubMed  Google Scholar 

  7. Debbs RH, DeLa Vega GA, Pearson S, Sehdev H, Marchiano D, Ludmir J (2007) Transabdominal cerclage after comprehensive evaluation of women with previous unsuccessful transvaginal cerclage. Am J Obstet Gynecol 197(3):317, e311–e314

    Article  Google Scholar 

  8. Moawad GN, Tyan P, Bracke T, Abi Khalil ED, Vargas V, Gimovsky A, Marfori C (2018) Systematic review of transabdominal cerclage placed via laparoscopy for the prevention of preterm birth. J Minim Invasive Gynecol 25(2):277–286

    Article  PubMed  Google Scholar 

  9. Burger NB, Brolmann HA, Einarsson JI, Langebrekke A, Huirne JA (2011) Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: systematic review. J Minim Invasive Gynecol 18(6):696–704

    Article  CAS  PubMed  Google Scholar 

  10. Liu Y, Ke Z, Liao W, Chen H, Wei S, Lai X, Chen X (2018) Pregnancy outcomes and superiorities of prophylactic cervical cerclage and therapeutic cervical cerclage in cervical insufficiency pregnant women. Arch Gynecol Obstet 297(6):1503–1508

    Article  PubMed  Google Scholar 

  11. Tulandi T, Alghanaim N, Hakeem G, Tan X (2014) Pre and post-conceptional abdominal cerclage by laparoscopy or laparotomy. J Minim Invasive Gynecol 21(6):987–993

    Article  PubMed  Google Scholar 

  12. Clark NV, Einarsson JI (2020) Laparoscopic abdominal cerclage: a highly effective option for refractory cervical insufficiency. Fertil Steril 113(4):717–722

    Article  PubMed  Google Scholar 

  13. Tian S, Zhao S, Hu Y (2021) Comparison of laparoscopic abdominal cerclage and transvaginal cerclage for the treatment of cervical insufficiency: a retrospective study. Arch Gynecol Obstet 303(4):1017–1023

    Article  PubMed  Google Scholar 

  14. Sneider K, Christiansen OB, Sundtoft IB, Langhoff-Roos J (2017) Recurrence rates after abdominal and vaginal cerclages in women with cervical insufficiency: a validated cohort study. Arch Gynecol Obstet 295(4):859–866

    Article  PubMed  Google Scholar 

  15. Bolla D, Gasparri ML, Badir S, Bajka M, Mueller MD, Papadia A, Raio L (2017) Cervical length after cerclage: comparison between laparoscopic and vaginal approach. Arch Gynecol Obstet 295(4):885–890

    Article  PubMed  Google Scholar 

  16. Ades A, Aref-Adib M, Parghi S, Hong P (2018) Laparoscopic transabdominal cerclage in pregnancy: A single centre experience. Aust N Z J Obstet Gynaecol 59(3):351–355

    Article  PubMed  Google Scholar 

  17. Shaltout MF, Maged AM, Elsherbini MM, Elkomy RO (2016) Laparoscopic transabdominal cerclage: new approach. J Matern Fetal Neonatal Med 30(5):600–604

    Article  PubMed  Google Scholar 

  18. Zaveri V, Aghajafari F, Amankwah K, Hannah M (2002) Abdominal versus vaginal cerclage after a failed transvaginal cerclage: a systematic review. Am J Obstet Gynecol 187(4):868–872

    Article  PubMed  Google Scholar 

  19. Huang X, Saravelos SH, Li TC, Huang R, Xu R, Zhou Q, Ma N, Xia E (2019) Cervical cerclage in twin pregnancy. Best Pract Res Clin Obstet Gynaecol 59:89–97

    Article  PubMed  Google Scholar 

  20. Lee AC, Quaiyum MA, Mullany LC, Mitra DK, Labrique A, Ahmed P, Uddin J, Rafiqullah I, DasGupta S, Mahmud A, Koumans EH, Christian P, Saha S et al (2015) Screening and treatment of maternal genitourinary tract infections in early pregnancy to prevent preterm birth in rural Sylhet, Bangladesh: a cluster randomized trial. BMC Pregnancy Childbirth 15:326

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wagura P, Wasunna A, Laving A, Wamalwa D, Ng'ang'a P (2018) Prevalence and factors associated with preterm birth at kenyatta national hospital. BMC Pregnancy Childbirth 18(1):107

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhou X, Li XX, Ge YM, Lai SY, Zhou LQ, Feng L, Zhao J (2022) Effects of vaginal microbiota and cervical cerclage on obstetric outcomes of twin pregnancies with cervical incompetence: a retrospective study. Arch Gynecol Obstet 305(1):77–86

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors acknowledge the physicians and nurses from the first affiliated hospital of Sun Yat-Sen University for their help in reserving all the clinical information. We also thank all the patients for the providing of their maternal and neonatal information when we have the telephone follow-up.

Funding

Not applicable.

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Author notes

  1. Tiefeng Cao, Jinhui Li contributed equally to this work.

Authors and Affiliations

  1. Department of Gynecology and Obstetrics, First Affiliated Hospital of Sun Yat-sen University, 58 zhongshan 2nd road, Yuexiu District, Guangzhou, 510070, Guangdong, People’s Republic of China

    Tiefeng Cao, Jinhui Li & Huimin Shen

Authors
  1. Tiefeng Cao
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  2. Jinhui Li
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  3. Huimin Shen
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Contributions

JL and TC collected the data, analyzed data and prepared tables and figures. TC wrote the main manuscript text. HS critically reviewed and revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Huimin Shen.

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The authors declare that they have no conflict of interest.

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Supplementary Information

Below is the link to the electronic supplementary material.

404_2022_6617_MOESM1_ESM.pdf

Supplementary file1 Figure S1. Maternal demographics of pregnant cases. A, Maternal age (y); B, Maternal gestation; C, GA at surgery (wks); D, CI (m); E, Hospitalizations (D). LTC, laparoscopic cerclage for twin pregnancies group; LSC, laparoscopic cerclage for singleton pregnancies group; VTC, transvaginal cerclage for twin pregnancies group; VSC, transvaginal cerclage for singleton pregnancies group; GA, gestational age; wks, weeks; CL, cervical length (PDF 50 KB)

Supplementary file2 (DOCX 16 KB)

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Cao, T., Li, J. & Shen, H. The comparative analysis of laparoscopic or transvaginal cerclage in pregnancies with cervical insufficiency: a retrospective cohort study. Arch Gynecol Obstet 307, 1415–1422 (2023). https://doi.org/10.1007/s00404-022-06617-x

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  • DOI: https://doi.org/10.1007/s00404-022-06617-x

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