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 transabdom inal or a transvaginal cerclage. STUDY DESIGN: We conducted a retrospective cohort study of singleton pregna ncies in women who had undergone (9-14 weeks) either a transabdominal or a transvaginal prophylactic cerclage after greater than or equal to1 prior fa iled 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 we re performed by a single attending physician (George Davis, DO). Patients w ith 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 differe d in age (34.0 +/- 4.2 vs 31.3 +/- 4.6 years, respectively; P = .01). The t ransabdominal 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) th an the transvaginal cerclage group. Preterm delivery at both <35 and <33 we eks' 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 t ransabdominal cerclage group and 32.8 +/- 8.6 weeks in the transvaginal cer clage group (P = .03). Preterm premature rupture of membranes also occurred less often in the transabdominal cerclage group than in the transvaginal c erclage group (8% vs 29%, P = .03). CONCLUSION: In patients with a prior failed transvaginal cerclage, transabd ominal cerclage is associated with a lower incidence of preterm delivery an d preterm premature rupture of membranes in comparison with transvaginal ce rclage.