Abstract
This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.
Highlights
The psychological impact of pregnancy loss is well known [1], and the loss of a wanted pregnancy at any stage is distressing, especially if it is a part of a pattern of recurrent pregnancy loss (RPL)
Randomized Cerclage Trial (CIPRACT), as “the initial, painless, progressive dilatation of the uterine cervix, where preterm birth seems inevitable without interference” [5]
As it has been established that cervical cerclage can correct cervical incompetence [7], we explored the possibility that a laparoscopic cerclage procedure could interrupt RPL
Summary
The psychological impact of pregnancy loss is well known [1], and the loss of a wanted pregnancy at any stage is distressing, especially if it is a part of a pattern of recurrent pregnancy loss (RPL). Risk factors for RPL include epidemiological, genetic, and endocrine factors; antiphospholipid syndrome; and anatomical disorders, including congenital malformation, intrauterine adhesions, fibroids, and cervical incompetence [3]. Cervical incompetence usually occurs in the second or early third trimester [4] and is defined, according to the inclusion criteria for the Cervical Incompetence Prevention. Randomized Cerclage Trial (CIPRACT), as “the initial, painless, progressive dilatation of the uterine cervix, where preterm birth seems inevitable without interference” [5]. Cervical incompetence can be diagnosed in the absence of other causes of preterm birth, such as uterine anomaly, fibroids, or infection. Cervical cerclage is an effective surgical procedure for the prevention of miscarriage due to cervical factors, and cervical incompetence, which is estimated to occur in about
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