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Transabdominal and laparoscopic cervicoisthmic cerclage

Authors
Errol R Norwitz, MD, PhD, MBA
Jon Ivar Einarsson, MD, PhD, MPH
Section Editor
Charles J Lockwood, MD, MHCM
Deputy Editor
Vanessa A Barss, MD, FACOG

INTRODUCTION

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.

                  
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Literature review current through: Nov 2017. | This topic last updated: Dec 06, 2017.
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