Transabdominal and laparoscopic cervicoisthmic cerclage
- Errol R Norwitz, MD, PhD, MBA
Errol R Norwitz, MD, PhD, MBA
- Professor and Chair
- Department of Obstetrics and Gynecology
- Tufts Medical Center and Tufts University School of Medicine
- Jon Ivar Einarsson, MD, PhD, MPH
Jon Ivar Einarsson, MD, PhD, MPH
- Director of Minimally Invasive Gynecologic Surgery
- Brigham and Women's Hospital
Transabdominal placement of a cerclage at the cervicoisthmic junction appears to be a safe and effective procedure for reducing the incidence of spontaneous pregnancy loss in selected patients with cervical insufficiency. This topic will discuss issues related to transabdominal cervicoisthmic cerclage. Issues related to cervical insufficiency and transvaginal cervical cerclage are reviewed separately. (See "Cervical insufficiency" and "Transvaginal cervical cerclage".)
CHOOSING A TRANSABDOMINAL VERSUS A TRANSVAGINAL APPROACH
The open transabdominal approach is obviously a more morbid procedure than the transvaginal approach, since a laparotomy is performed for placement and later for cesarean delivery. The procedure can also be performed laparoscopically, which is minimally invasive and thus associated with more rapid recovery but still more morbid than the transvaginal approach. Given the increased morbidity of any transabdominal procedure compared with a transvaginal procedure, most experts recommend reserving the transabdominal approach for women with cervical insufficiency who meet one (or both) of the following criteria:
●Failed to deliver a healthy newborn after at least one previous elective transvaginal cerclage (ie, does not include a rescue cerclage performed for advanced cervical dilation on physical examination).
The type of elective cerclage does not influence our decision. No compelling evidence indicates that, before resorting to a transabdominal approach, a Shirodkar cerclage should be attempted in the pregnancy after a failed prophylactic McDonald cerclage.
●Are unable to undergo a transvaginal procedure because an extremely short or absent cervix, amputated cervix, marked cervical scarring, or cervical defect make it technically impossible to perform.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- CHOOSING A TRANSABDOMINAL VERSUS A TRANSVAGINAL APPROACH
- APPROACH TO PATIENTS PRESENTING PRECONCEPTION
- APPROACH TO PATIENTS PRESENTING IN EARLY PREGNANCY
- Open transabdominal approach
- Laparoscopic approach
- - Cervicoisthmic cerclage via a transvaginal approach
- POSTOPERATIVE CARE
- Management of the cerclage after delivery
- MANAGEMENT OF FETAL DEMISE
- First trimester
- Early to mid second trimester
- Late second trimester and third trimester
- SUMMARY AND RECOMMENDATIONS