Laparoscopic cervical cerclage and pregnancy outcomes in consecutive pregnancies: An observational study

INTRODUCTION: Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is known about pregnancy outcomes when a cerclage is left in situ across consecutive pregnancies; this study aims to investigate neonatal outcomes following laparoscopic cervical cerclage placement in first and subsequent pregnancies and to compare pre- and postconception placement of the laparoscopic cervical cerclage on neonatal survival. MATERIAL AND METHODS: We performed an observational study in women who had a laparoscopic cervical cerclage at Aarhus University Hospital, Denmark, between 2011 and 2021. Data on the timing of the procedure (pre- vs post-conception), surgical complications, obstetric, and neonatal outcomes were collected from electronic patient records and analyzed descriptively. The primary outcome was neonatal survival. Secondary outcomes were neonatal survival without major morbidity, preterm birth, and gestational age at birth. RESULTS: A total of 170 women had a laparoscopic cervical cerclage during the study period. Uterine wall perforation occurred in 10/170 procedures (6%), postoperative infection in 4/170 (2%), and 125/170 (74%) were discharged on the same day as the procedure. There were 145 women with at least one subsequent pregnancy and 229 registered pregnancies in total. In the 185 pregnancies that progressed beyond 20 weeks, 166/181 (92%) delivered ≥34 weeks of gestation. Neonatal survival was 183/186 (98%), and survival without major morbidity was 181/186 (97%). Neonatal outcomes were similar between women with a cerclage placed pre- or postconception. Fifty of 145 women (34%) with a cerclage left in situ had more than one pregnancy beyond 20 weeks of gestation. These repeated pregnancies showed consistently favorable outcomes, with neonatal survival rates of 100% in second pregnancies (44/44) and 100% in third pregnancies (4/4). CONCLUSIONS: Laparoscopic cervical cerclage supports favorable neonatal outcomes in first and subsequent pregnancies. Neonatal outcomes did not appear to differ based on whether the cerclage was placed pre- or postconception. Pregnancies in which the cerclage was left in situ demonstrated high neonatal survival rates and favorable obstetric outcomes in both second and third pregnancies.