Transvaginal Cervical Cerclage in Cervical Insufficiency: Outcomes of 77 Pregnancies: Single Institution Retrospective Study

Abstract

Background: Cervical insufficiency is a major cause of second-trimester pregnancy loss and spontaneous preterm delivery. Cervical cerclage is a surgical procedure that can be performed in an attempt to maintain the structural integrity of the cervix in order to prolong gestation and improve obstetrical outcomes. Objective: The aim of the study was to investigate the effectiveness of the transvaginal cervical cerclage (TVCs). Materials and methods: A single-institution retrospective study included 106 pregnant women (93 singleton pregnancies and 13 twin pregnancies) who underwent transvaginal cerclage between 2015 and February 2022. Data extracted included patient demographics, gestation of suture insertion, gestation at delivery, mode of delivery, pregnancy outcomes and details about the suture insertion. The main outcomes of pregnancy which were evaluated were live birth rate and gestation at delivery. Results: During the study period, 106 women underwent transvaginal cerclage between 14 and 30 weeks of gestation. Cervical cerclages were done by the McDonald (n=105) or the Shirodkar technique (n=1). Regarding the mode of the delivery, cesarean section was performed in 59 cases (77%), in 18 cases it was vaginal delivery (23%). The outcomes of 77 pregnancies (88 babies) were analyzed. The live birth rate was 97,7%, a mean gestational age at delivery of 36 weeks; the preterm birth rate at <32 weeks was 19,5%, only 1,3% women delivered before 24 weeks. Conclusion: Placement of transvaginal cerclage appears to reduce preterm delivery before 32 weeks and improve neonatal survival. It appears to be a safe and effective procedure.