Analysis of therapeutic effect of laparoscopic cervical cerclage and transvaginal cervical cerclage in patients with cervical incompetence during pregnancy

Abstract:

Objective To investigate the pregnancy outcomes and ultrasonic changes of cervical length in patients with cervical incompetence（CI） after laparoscopic cervical cerclage（LAC） and transvaginal cervical cerclage（TVC） during pregnancy，and to further explore the indications of laparoscopic cerclage.Methods We retrospective analyzed the data of 115 patients who underwent cervical cerclage in our hospital due to CI during pregnancy from June 2016 to February 2022. Among them，there were 65 patients who underwent LAC（LAC group），35 patients with previous TVC failure，and 30 patients with previous cervical conization；there were 50 patients who underwent TVC（TVC group），none of which had previous TVC failure， and 20 patients had previous cervical conization. Pregnancy outcomes，intraoperative conditions，postoperative complications and cervical length measured by ultrasound during pregnancy were compared between the two groups.Results The previous TVC failure rate in LAC group was significantly higher than that in TVC group （53.8% vs. 0.0%，P<0.05），and there were no statistically significant differences in the rate of previous cervical conization between the two groups（46.1% vs. 40.0%，P>0.05）. The full-term delivery rate， neonatal survival rate，gestational weeks of delivery and postoperative prolongation of gestational weeks［83.0%，100.0%，（36.5±4.0） weeks，（17.0±4.2） weeks］ in LAC group were significantly higher than those in TVC group［44.0%，76.2%，（32.0±5.2） weeks，（13.2±4.3）weeks］（P<0.05）. The rates of premature birth and inevitable abortion in TVC group（40.0%，16.0%） were significantly higher than those in LAC group（12.3%，4.6%）（P<0.05）. There were no postoperative complications in the LAC group，but 8 cases （16.0%） in the TVC group，including 1 case of cervical laceration and 7 cases of postoperative infection. The incidence of postoperative complications in the TVC group was higher than that in the LAC group（P<0.05）. The cervix length prior to surgery was similar in both groups. After cervical cerclage placement，there was a statistical difference in the distance between the tape and the external cervical orifice between the two groups［LAC group：（28.7±4.6） mm vs. （12.3±4.2） mm，P<0.05］. During pregnancy，the cervical length was significantly shortened in the TVC group［from （25.0±2.0） mm before surgery to （12.0±4.5） mm at delivery，P<0.05］，while in the LAC group，the cervical length remained unchanged.Conclusion In patients with CI during pregnancy，LAC is safe and effective，and its pregnancy outcomes are better than those of TVC，possibly because LAC can better preserve the length of the cervix throughout pregnancy as compared to TVC. LAC is recommended as the first choice for patients with previous TVC failure and a short cervix after previous cervical conization.