Elective and emergency transabdominal cervicoisthmic cerclage for cervical incompetence.

OBJECTIVE

To evaluate the success rate of transabdominal cervicoisthmic cerclage (TACIC) as an elective and emergency procedure for cervical incompetence in comparison to reported success rates for vaginal cerclage.

STUDY

DESIGN

Retrospective review was performed of the hospital records of patients and their neonates who underwent TACIC for cervical incompetence by the Maternal-Fetal Medicine Service, Harrisburg Hospital. Data regarding procedure indications, maternal age, gravidity/parity, gestational age at time of placement, pregnancy outcome, delivery age and fetal weight at delivery were recorded. Comparison was made to previously reported outcomes for vaginal cerclage.

RESULTS

Thirteen patients underwent TACIC from July 1996 through April 2001. The overall viable delivery rate was 76.9%. Five procedures were emergency, with a viable delivery rate of 60%. Mean gestational age at delivery for this group was 34.6 weeks. The 8 elective procedures had a viable delivery rate of 87.5% and mean gestational age of 35.5 weeks. Complications from the TACIC procedure were limited to a single catheter-related urinary tract infection.

CONCLUSION

In pregnancies complicated by cervical incompetence and in which Shirodkar or McDonald cerclage has previously failed or is not technically feasible, TACIC offers the possibility of a successful outcome in elective and emergency settings similar to that previously reported for vaginal cerclage.