Cervicoisthmic cerclage: transabdominal vs transvaginal approach

Published:April 20, 2009DOI:


      We sought to compare the outcomes of cervicoisthmic (CI) cerclage using traditional transabdominal (TA) approach vs the lesser used transvaginal (TV) approach.

      Study Design

      We conducted a retrospective cohort study of women who underwent placement of a CI cerclage.


      Before CI placement, the abdominal group had a total of 100 pregnancies that continued beyond the first trimester and had 27 (27%) surviving infants. After cerclage placement, there were 34 pregnancies and 24 (71%) surviving infants. Before cerclage placement, the vaginal group had a total of 90 pregnancies that continued beyond the first trimester and had 11 (12%) surviving infants. After cerclage placement, there were 29 pregnancies and 20 (69%) surviving infants. The vaginal cerclage group had a significantly shorter mean operative time of 33 vs 69 minutes, and shorter hospital stay of 0.5 vs 3.2 days.


      Both TV and TA CI cerclage offers select patients with cervical insufficiency improved neonatal survival. The TV placement of a CI has less morbidity than the TA approach with a comparable neonatal survival.

      Key words

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        • Lotgering F.
        Clinical aspects of cervical insufficiency.
        BMC Pregnancy Childbirth. 2007; 7: S17
        • Lidegaard O.
        Cervical incompetence and cerclage in Denmark 1980-1990: a register-based epidemiological survey.
        Acta Obstet Gynecol Scand. 1994; 73: 35-38
        • Shirodkar V.
        A new method of operative treatment of habitual abortions in the second trimester of pregnancy.
        Antiseptic. 1955; 52: 299-300
        • McDonald I.
        Suture of the cervix for inevitable miscarriage.
        J Obstet Gynaecol Br Emp. 1957; 64: 346-353
        • Benson R.C.
        • Durfee R.B.
        Transabdominal cervicouterine cerclage during pregnancy for the treatment of cervical incompetency.
        Obstet Gynecol. 1965; 25: 145-155
        • Mahran M.
        Transabdominal cervical cerclage during pregnancy: a modified technique.
        Obstet Gynecol. 1978; 52: 503-506
        • Novy M.J.
        Transabdominal cervicoisthmic cerclage for the management of repetitive abortion and premature delivery.
        Am J Obstet Gynecol. 1982; 143: 44-54
        • Olsen S.
        • Tobiassen T.
        Transabdominal isthmic cerclage for the treatment of incompetent cervix.
        Acta Obstet Gynecol Scand. 1982; 61: 473-475
        • Herron M.A.
        • Parer J.T.
        Transabdominal cerclage for fetal wastage due to cervical incompetence.
        Obstet Gynecol. 1988; 71: 865-868
        • Novy M.J.
        Transabdominal cervicoisthmic cerclage: a reappraisal 25 years after its introduction.
        Am J Obstet Gynecol. 1991; 164: 1635-1642
        • Gibb D.M.
        • Salaria D.A.
        Transabdominal cervicoisthmic cerclage in the management of recurrent second trimester miscarriage and preterm delivery.
        Br J Obstet Gynaecol. 1995; 102: 802-806
        • Cammarano C.L.
        • Herron M.A.
        • Parer J.T.
        Validity of indications for transabdominal cervicoisthmic cerclage for cervical incompetence.
        Am J Obstet Gynecol. 1995; 172: 1871-1875
        • Anthony G.S.
        • Walker R.G.
        • Cameron A.D.
        • et al.
        Transabdominal cervico-isthmic cerclage in the management of cervical incompetence.
        Eur J Obstet Gynecol Reprod Biol. 1997; 72: 127-130
        • Craig S.
        • Fliegner J.R.H.
        Treatment of cervical incompetence by transabdominal cervicoisthmic cerclage.
        Aust N Z Obstet Gynecol. 1997; 37: 407-411
        • Zaveri V.
        • Aghajafari F.
        • Amankwah K.
        • Hannah M.
        Abdominal versus vaginal cerclage after a failed transvaginal cerclage: A systematic review.
        Am J Obstet Gynecol. 2002; 187: 868-872
        • Cho C.H.
        • Kim T.H.
        • Kwon S.H.
        • Kim J.I.
        • Yoon S.D.
        • Cha S.D.
        Laparoscopic transabdominal cervicoisthmic cerclage during pregnancy.
        J Am Assoc Gynecol Laparosc. 2003; 10: 363-366
        • Golfier F.
        • Bessai K.
        • Paparel P.
        • Cassignol A.
        • Vaudoyer F.
        • Raudrant D.
        Transvaginal cervicoisthmic cerclage as an alternative to the transabdominal technique.
        Eur J Obstet Gynecol Reprod Biol. 2001; 100: 16-21
        • Katz M.
        • Abrahams M.S.
        Transvaginal placement of cervicoisthmic cerclage: report on pregnancy outcome.
        Am J Obstet Gynecol. 2005; 192: 1989-1992
        • Deffieux X.
        • De Tayrac R.
        • Louafi N.
        • et al.
        Novel application of polypropylene sling: Transvaginal cervicoisthmic cerclage in women with high risk of preterm delivery.
        J Minim Invasive Gynecol. 2006; 13: 216-221