Different cerclage for cervical insufficiency: more of the same? A systematic review on perinatal outcomes of pre-conception laparoscopic transabdominal and elective transvaginal cervical cerclage

ABSTRACT

Background. Cervical cerclage (CC) prevents preterm birth and mid-trimester loss (MTL) in women with cervical insufficiency. While transvaginal cerclage (TVC) is commonly used, laparoscopic abdominal cerclage (LAC) is an alternative for those with anatomical limitations. This systematic review compares pregnancy outcomes between elective TVC and pre-conceptional LAC.

Methods. Following PRISMA guidelines, we conducted a systematic search in PubMed, EMBASE, Scopus, Cochrane Library, and Science Direct in June 2024 using the terms “Elective Cervical cerclage” and “Laparoscopic cerclage.” Studies were included if they involved elective TVC or LAC and reported at least one outcome of interest: delivery <34 weeks gestation, MTL, infection, or neonatal survival. Non-original and non-English studies were excluded.

Results. 13 studies involving 1,259 patients (601 TVC, 658 LAC) were analyzed. Delivery ≥34 weeks occurred in 71.3–87% of TVC and 71.4–100% of LAC cases. MTL was significantly higher with TVC (6.4% vs. 3.4%; p=0.0055). No significant differences were observed in preterm delivery <34 weeks (9.7% vs. 11.1%; p=0.053) or complication rates (2.8% vs. 1.9%; p=0.337).

Conclusions. While TVC has traditionally been preferred, recent evidence suggests that pre-conceptional LAC may be more effective for women with a history of cervical insufficiency. Further research is necessary to confirm these findings and assess the efficacy of LAC in other high-risk populations.