Efficacy of Laparoscopic and Trans-Abdominal Cerclage in Patients with Cervical Insufficiency: A Systematic Review and Meta-Analysis

Abstract

<h3>Study Objective</h3> We aimed to conduct this systematic review and meta-analysis to investigate and compare the efficacy of laparoscopic and TAC in patients with CI. <h3>Design</h3> Systematic Review with Meta-analsysis. <h3>Setting</h3> We searched PubMed, Scopus, MEDLINE, ClinicalTrials.Gov, Cochrane and Web of Science using suitable keywords. Retrieved citations were screened for our criteria. We extracted all outcomes reported then analyzed using Open Meta-Analyst and Review Manager Software. <h3>Patients or Participants</h3> We included all study designs (observational and randomized controlled trials) that included patients with CI that underwent laparoscopic cerclage or TAC. We excluded non-English trials and full-text not available. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> We included a total of 43 studies. Laparoscopic and TAC had a positive effect by increasing gestational age; for laparoscopic (MD = 14.86 weeks (W), 95% CI [10.67, 19.05], P < 0.001) and TAC (MD = 12.79 W, 95% CI [10.97, 14.61], P < 0.001). Also, laparoscopic had a positive effect regarding neonatal survival (RR = 0.981, 95% CI [0.95, 1.012], P < 0.001) and TAC (RR = 0.23, 95% CI [0.18, 0.31], P < 0.00001). Furthermore, all outcomes assessed (total fetal survival rate, baby weight, operative time, hospital stay, gestational age > 34, < 34 and < 24 weeks) were significant except preterm delivery; laparoscopic (RR = 0.116, 95% CI [-0.006, 0.238], P = 0.063) and TAC (MD = 1, 95% CI [0.45, 2.24], P = 1), and Gestational age < 34 weeks for laparoscopic group (RR = 0.446, 95% CI [-0.323, 1.215], P = 0.256). <h3>Conclusion</h3> In patients with CI, both TAC and laparoscopic cerclage procedures revealed a positive effect in preserving the pregnancy. In contrast to previous reviews including fewer studies, our meta-analysis did not show a statistically significant difference in survival in the laparoscopic over trans-abdominal cerclage groups.