Transabdominal cervicoisthmic cerclage

Recurring miscarriage carries a great emotional trauma to women and is the most distressing problem in obstetrics especially in those who have no successful pregnancies. This article reviews the technique, outcome, indications and complications for the transabdominal cervicoisthmic cerclage procedure for cervical incompetence. Since its introduction more than 30 years ago, modifications have been made in patient selection criteria, surgical technique, timing of operation, and preoperative and postoperative patient management. Morbidity due to vascular trauma at the time of operation, remains a problem. Between 1965 and 1997, a total of 340 pregnancies in 284 patients were reported in the literature with an overall post treatment fetal salvage rate of 87% as compared to 17% before treatment. The reported successful outcome varied between 70-100%. Transabdominal cervicoisthmic cerclage may be a useful procedure in the selected patients whose cervix is either markedly foreshortened, deeply lacerated or infected and a previous failed transvaginal cerclage on one or more occasion. The optimum time for the operation is 10-14 weeks. The suture material, preferably infant-feeding tube is less traumatic acid the bulky knot easier to feel and remove through a posterior colpotomy should that become necessary. Despite its associated complications and morbidity, transabdominal cervicoisthmic cerclage is an effective operation which gives hope for mothers with a badly scarred or damaged cervix with recurrent fetal death to have a live child.