Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage.

Objective: Our purpose was to compare the incidence of preterm birth after a prior failed vaginal cerclage in patients who had a subsequent transabdominal or a transvaginal cerclage.

Study Design: We conducted a retrospective cohort study of singleton pregnancies in women who had undergone (9-14 weeks) either a transabdominal or a transvaginal prophylactic cerclage after >/=1 prior failed transvaginal cerclage. Prior failed transvaginal cerclage was defined as a preterm birth at <33 weeks' gestation in the immediate prior pregnancy despite a transvaginal cerclage. All transabdominal cerclage procedures were performed by a single attending physician (George Davis, DO). Patients with a cervix too short for transvaginal cerclage placement, placenta previa, or major fetal anomalies were excluded. Primary outcome was preterm birth at <35 weeks' gestation.

Results: Forty transabdominal and 24 transvaginal cerclage pregnancies were analyzed. These 2 groups were similar in race and payer status but differed in age (34.0 +/- 4.2 vs 31.3 +/- 4.6 years, respectively; P =.01). The transabdominal cerclage group had more prior failed cerclage procedures per patient (1.8 +/- 1.0 vs 1.1 +/- 0.3; P =.02) and more prior 14- to 24-week spontaneous abortions per patient (2.4 +/- 1.3 vs 1.5 +/- 1.0; P =.02) than the transvaginal cerclage group. Preterm delivery at both <35 and <33 weeks' gestation was less common in the transabdominal cerclage group (18% vs 42%, P =.04; 10% vs 38%, P =.01; respectively) than in the transvaginal cerclage group. Gestational age at delivery was 36. 3 +/- 4.1 weeks in the transabdominal cerclage group and 32.8 +/- 8. 6 weeks in the transvaginal cerclage group (P =.03). Preterm premature rupture of membranes also occurred less often in the transabdominal cerclage group than in the transvaginal cerclage group (8% vs 29%, P =.03).

Conclusion: In patients with a prior failed transvaginal cerclage, transabdominal cerclage is associated with a lower incidence of preterm delivery and preterm premature rupture of membranes in comparison with transvaginal cerclage.