ABSTRACT
To assess the efficacy of performing transvaginal cervico-isthmic cerclage [CIC] using synthetic tape in prevention of preterm labor in high-risk women. A retro and prospective analysis of 23 transvaginal cerclages using polypropylene tape performed in women presenting with high risk of preterm delivery: prior histories of two or more losses in the second trimester and/or prior failure of Hervet or Mac Donald's cerciage. Cerclage was at 14 weeks of gestation. A polypropylene tape was placed at the cervicoisthmic junction by vaginal route. The median age of the patients in this series was 33.2 years [range 25-41 years]. No intra-operative complication occurred. The median operating time was 36.9 minutes [ +/- 4.1] [range 30-45 min]. Cesarean delivery was systematically performed in all patients since the Cerclage was considered to be definitive. Term birth rate was 57.5% [3% before CIC; p<0.0001]. Pregnancy loss in the second trimester was 7.8% [66% before CIC; p<0.0001]. Preterm birth rate was 23.1% [[31% before CIC]. Birth at less than 28 weeks occurred in only 1 patients [3.7%] [10.7% before CIC]. In one case, the tape has been removed later because of secondary displacement. Amniotic fluid infection occurred in 4 cases [5%]. Living birth rate was 80.7% [21% before CIC] and no neonatal death occurred [13% before CIC]. Transvaginal cerclage using polypropylene tape may be considered as an effective and minimally invasive alternative to transabdominal cervico-isthmic cerclage in women presenting with high risk of preterm delivery