Frontiers in reproductive health · 2026
Comparative study on the clinical efficacy of laparoscopic cervicoisthmic cerclage and transvaginal cervical cerclage in the treatment of cervical insufficiency after hysteroscopic adhesiolysis for intrauterine adhesions: a retrospective cohort study.
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Fan Hui-Liu, Wu Xiao-Xia, Wen Zhen-Zhen, Wei Hong-Lan
Аннотация
INTRODUCTION: This study compared the clinical efficacy of laparoscopic cervical cerclage (LAC) and transvaginal cervical cerclage (TVC) in treating cervical insufficiency (CI) patients after hysteroscopic adhesiolysis for intrauterine adhesions (IUA).
METHODS: A total of 170 eligible patients (66 in the LAC group, 104 in the TVC group) admitted from Jan 2018 to Jan 2024 were retrospectively analyzed, with LAC performed pre-pregnancy and transvaginal McDonald cerclage performed at 12-16 weeks of gestation in the TVC group. Pregnancy outcomes and surgical safety were compared between the two groups, with subgroup analysis conducted by IUA severity.
RESULTS: Results showed that the LAC group had a significantly higher term delivery rate (89.4% vs. 71.2%, P = 0.005) and neonatal survival rate (98.5% vs. 90.4%, P = 0.027), and a lower preterm birth rate before 34 weeks (9.1% vs. 20.2%, P = 0.036) than the TVC group. In terms of safety, the LAC group had a lower infection rate (3.0% vs. 10.6%, P = 0.029) and suture slippage rate (1.5% vs. 9.6%, P = 0.015), while the TVC group had a higher cervical laceration rate (5.8% vs. 1.5%, P = 0.048). The LAC group had 2 mild intraoperative complications (1.5% each), all resolved with timely treatment, whereas the TVC group had no severe intraoperative complications. The LAC group had a markedly higher cesarean section rate (98.5% vs. 26.9%, P < 0.001). Subgroup analysis indicated that the LAC group had a significantly higher term delivery rate in moderate-to-severe IUA patients (88.1% vs. 71.0%, P = 0.005), with no significant difference in mild IUA patients (91.7% vs. 71.4%, P > 0.05). In conclusion, LAC is superior to TVC in improving the term delivery rate and reducing late miscarriage in CI patients after IUA surgery, especially for those with moderate-to-severe IUA. TVC, with minimal invasion and preserved vaginal delivery chance, is suitable for mild IUA patients with good cervical conditions and a willingness for vaginal delivery. Individualized surgical selection is recommended in clinical practice.
METHODS: A total of 170 eligible patients (66 in the LAC group, 104 in the TVC group) admitted from Jan 2018 to Jan 2024 were retrospectively analyzed, with LAC performed pre-pregnancy and transvaginal McDonald cerclage performed at 12-16 weeks of gestation in the TVC group. Pregnancy outcomes and surgical safety were compared between the two groups, with subgroup analysis conducted by IUA severity.
RESULTS: Results showed that the LAC group had a significantly higher term delivery rate (89.4% vs. 71.2%, P = 0.005) and neonatal survival rate (98.5% vs. 90.4%, P = 0.027), and a lower preterm birth rate before 34 weeks (9.1% vs. 20.2%, P = 0.036) than the TVC group. In terms of safety, the LAC group had a lower infection rate (3.0% vs. 10.6%, P = 0.029) and suture slippage rate (1.5% vs. 9.6%, P = 0.015), while the TVC group had a higher cervical laceration rate (5.8% vs. 1.5%, P = 0.048). The LAC group had 2 mild intraoperative complications (1.5% each), all resolved with timely treatment, whereas the TVC group had no severe intraoperative complications. The LAC group had a markedly higher cesarean section rate (98.5% vs. 26.9%, P < 0.001). Subgroup analysis indicated that the LAC group had a significantly higher term delivery rate in moderate-to-severe IUA patients (88.1% vs. 71.0%, P = 0.005), with no significant difference in mild IUA patients (91.7% vs. 71.4%, P > 0.05). In conclusion, LAC is superior to TVC in improving the term delivery rate and reducing late miscarriage in CI patients after IUA surgery, especially for those with moderate-to-severe IUA. TVC, with minimal invasion and preserved vaginal delivery chance, is suitable for mild IUA patients with good cervical conditions and a willingness for vaginal delivery. Individualized surgical selection is recommended in clinical practice.