Laparoscopic Uterine Cerclage: A 10 Year Experience at a Tertiary Referral Centre

Abstract

Study Objective To determine the safety and efficacy of all cases of laparoscopic uterine cerclage performed in a tertiary referral center in the last 10 years. Design Retrospective Cohort Study. Setting Tertiary referral center and university teaching hospital. Patients or Participants All patients who underwent laparoscopic uterine cerclage from March 2010 to March 2019. Interventions Laparoscopic insertion of uterine cerclage. Measurements and Main Results A total of 14 cases were identified. 14/14 patients presented with a history of recurrent pregnancy loss or extreme premature labor (below 26 weeks). Indication included further mid-trimester loss or extreme premature labor despite elective cervical cerclage (8/14), failed rescue cerclage (3/14) and a short cervix on ultrasound or failure to insert cervical cerclage (3/14). No intra-operative complications were noted. Mean operating time was 98 minutes (Range 68-124). No post-operative complications or readmissions were noted. Of the 12 patients who underwent surgery greater than 12 months ago, there were 12 spontaneous conceptions (11/12 patients), 1 miscarriage and 11 livebirths after 37 weeks gestation by elective or emergency caesarean section. In the patient who suffered a miscarriage a surgical evacuation was carried out without complication. Conclusion Laparoscopic uterine cerclage remains a novel technique with a strict inclusion criteria requiring regular surveillance and audit of outcomes. This has limited the number of cases performed and there are currently no robust randomized control trials comparing management options for women with recurrent pregnancy loss after cervical cerclage. Despite the small numbers our results indicate that this technique has a good safety profile and outcomes in livebirths rates >34 weeks are good. Our results supports expansion of this service at a regional level through multi-disciplinary assessment to enable this technique can becoming established practice. To determine the safety and efficacy of all cases of laparoscopic uterine cerclage performed in a tertiary referral center in the last 10 years. Retrospective Cohort Study. Tertiary referral center and university teaching hospital. All patients who underwent laparoscopic uterine cerclage from March 2010 to March 2019. Laparoscopic insertion of uterine cerclage. A total of 14 cases were identified. 14/14 patients presented with a history of recurrent pregnancy loss or extreme premature labor (below 26 weeks). Indication included further mid-trimester loss or extreme premature labor despite elective cervical cerclage (8/14), failed rescue cerclage (3/14) and a short cervix on ultrasound or failure to insert cervical cerclage (3/14). No intra-operative complications were noted. Mean operating time was 98 minutes (Range 68-124). No post-operative complications or readmissions were noted. Of the 12 patients who underwent surgery greater than 12 months ago, there were 12 spontaneous conceptions (11/12 patients), 1 miscarriage and 11 livebirths after 37 weeks gestation by elective or emergency caesarean section. In the patient who suffered a miscarriage a surgical evacuation was carried out without complication. Laparoscopic uterine cerclage remains a novel technique with a strict inclusion criteria requiring regular surveillance and audit of outcomes. This has limited the number of cases performed and there are currently no robust randomized control trials comparing management options for women with recurrent pregnancy loss after cervical cerclage. Despite the small numbers our results indicate that this technique has a good safety profile and outcomes in livebirths rates >34 weeks are good. Our results supports expansion of this service at a regional level through multi-disciplinary assessment to enable this technique can becoming established practice.