Analysis of maternal and neonatal outcomes using cervical cerclage or conservative treatment in singleton gestations with a sonographic short cervix.

ABSTRACT: To investigate the effect of cervical cerclage or conservative treatment on maternal and neonatal outcomes in singleton gestations with a sonographic short cervix, and further compare the relative treatment value.A retrospective study was conducted among women with singleton gestations who had a short cervical length (<25 mm) determined by ultrasound during the period of 14 to 24 weeks' gestation in our institution. We collected clinical data and grouped the patients according to a previous spontaneous preterm birth (PTB) at <34 weeks of gestation or second trimester loss (STL) and sub-grouped according to treatment option, further comparing the maternal and neonatal outcomes between different groups.In the PTB or STL history cohort, the cerclage group had a later gestational age at delivery (35.3 ±â€Š3.9 weeks vs 31.6 ±â€Š6.7 weeks) and a lower rate of perinatal deaths (2% vs 29.3%) compared with the conservative treatment group. In the non-PTB-STL history cohort, the maternal and neonatal outcomes were not significantly different between the cerclage group and conservative treatment group. More importantly, for patients with a sonographic short cervix who received cervical cerclage, there was no significant difference in the maternal and neonatal outcomes between the non-PTB-STL group and PTB or STL group.For singleton pregnant with a history of spontaneous PTB or STL and a short cervical length (<25 mm), cervical cerclage can significantly improve maternal and neonatal outcomes; however, conservative treatment (less invasive and expensive than cervical cerclage) was more suitable for those pregnant women without a previous PTB and STL history.

Robotic transabdominal cerclage: a case series illustrating costs.

The incidence of cervical insufficiency is 0.1-1% of all pregnancies and 8% of second trimester losses. After failed vaginal cerclages or in patients with amputated or congenitally abnormal cervices, transabdominal cerclages may be performed. Recent advances allow for use of the da Vinci robot to perform transabdominal cerclages. This case series presents three cases of robotically placed cerclages, performed prior to pregnancy. All patients had experienced prior second trimester losses. Two of the three had previously failed vaginal cerclage placement. All patients were discharged home the same day with minimal intraoperative blood loss and postoperative pain. Though, historically, robotic surgeries are more expensive, the total hospital costs for the three robotic cerclages were similar to the open abdominal approach performed at the same institution. These cases suggest robotically placed cerclage as a viable and less invasive alternative to the traditional transabdominal cerclages.