(1115) Favorable Surgical and Obstetric Outcomes in Pre-and Postconceptional Laparoscopic Abdominal Cerclage: Large Multicenter Cohort Study

To assess surgical and obstetric outcomes after pre- and postconceptional laparoscopic abdominal cerclage (LAC) placement, including subgroup analyses based on the indication for surgery.

Study Design:

A retrospective multicenter cohort study with consecutive inclusion of all eligible patients was conducted. Eligible patients had a second/third trimester fetal loss (FL) because of cervical incompetence and/or a short/absent cervix after cervical surgery. Patients were divided in a pre- and postconceptional cohort and then into subgroups based on indication for LAC: 1)prior failed vaginal cerclage (PFVC) 2)prior cervical surgery (PCS) 3)other indication (OI) e.g. multiple prior dilation and curettage. The primary outcome was delivery ≥34 weeks of gestation. Secondary outcomes were surgical and obstetric outcomes.

Results:

A total of 273 patients were included; 250 patients had pre- and 23 patients had postconceptional LAC.

Surgical outcomes were excellent with 6(2%) minor complications (uterine perforation) during preconceptional surgery.

Pregnancy rate after preconceptional LAC was 74%. A total of 140 completed pregnancies were evaluated; 120 after pre- and 20 after postconceptional LAC. First trimester FL occurred in 14%; 15% after pre- and 10% after postconceptional LAC.

Of all ongoing pregnancies 93% delivered ≥34 weeks of gestation; 91% after pre- and 94% after postconceptional LAC. Delivery ≥34 weeks of gestation occurred in 86%(n=57) in the subgroup PFVC, 93%(n=27) in the subgroup PCS and 100%(n=26) in the subgroup OI.

Second trimester FL occurred in 4 patients(3%) all in the subgroup PFVC of the preconceptional cohort.

Fetal survival rate of all ongoing pregnancies was 97%; 96% after pre- and 100% after postconceptional LAC. Fetal survival rate was 94% in the subgroup PFVC and 100% in the subgroup PCS and OI.

Conclusion:

Pre- and postconceptional LAC placement is a safe procedure with favorable obstetric outcomes in patients with an increased risk of cervical incompetence. Subgroup analysis identifies patients with a prior failed vaginal cerclage with the greatest risk of cervical incompetence.