Transvaginal cervico-isthmic cerclage using polypropylene tape: surgical procedure and pregnancy outcome

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