Transabdominal cervico-isthmic cerclage: 13 cases at Rouen University Hospital

Objective. - The aim of this study was to describe our experience with cervico-isthmic cerclage by abdominal approach and to assess this efficacy. Patients and methods. - A retrospective analysis of 13 transabdominal cerclages (eight by laparotomy and five by laparoscopy), seven cases performed before pregnancy and six cases between 12 and 14 weeks of gestation, between 2004 and 2009. We analyzed the previous obstetric accidents, the etiology of cervical incompetence and the patient outcome after cerclage. Results. - Median age of the patients was 35 years [27-42 years]. Patients had an average of pregnancy 4,2 [1-7], with 3,3 previous fetal losses or preterm delivery. Eighty percent had a prior failed transvaginal cerclage. The mean operative time of laparotomic cerclage was 100 minutes and 94 minutes by laparoscopy, with a mean hospitalization time respectively of seven and 2,5 days. No operative complication was reported. Eleven women were pregnant after cervico-isthmic cerclage: nine deliveries by caesarean section at term, and two preterm births between 34 and 37 weeks of gestation. Two patients are looking for being pregnant and one of those is currently doing a procedure of IVF. Discussion and Conclusion. - Transabdominal cervico-isthmic cerclage is an alternative technique for the management of cervical incompetence after failed vaginal cerclage. Our data indicated that the cervico-isthmic cerclage placed laparoscopically compares favorably with the laparotomy approach in regard to operative technique and risk of complications. (c) 2011 Elsevier Masson SAS. All rights reserved.