Laparoscopic Cerclage

Abstract

Preterm delivery is the most common cause of neonatal morbidity and mortality, with reported preterm birth rates in Europe and other developed countries around 5–11 % of all deliveries (Lawn et al. 2010). Cervical insufficiency contributes to both preterm delivery and second-trimester fetal loss. It has been conservatively reported that cervical insufficiency complicates approximately 0.1–1 % of all pregnancies, and estimates suggest that 8 % of women with repeated second or early third-trimester losses may be affected (Ludmir 1988; Scarantino et al. 2000). In a normal pregnancy, the cervix stays both closed, with substantial length (>3 cm) and only toward the end of term the cervix starts to progressively shorten, become effaced in preparation for normal labor and delivery. In some cases, however, the cervix starts to shorten and dilates pathologically early in gestation (Alfirevic et al. 2012). This condition has been described as early as the seventeenth century by Riverius and was formerly termed ‘cervical incompetence’. While this term has largely given way to the less pejorative, ‘cervical insufficiency’ they both refer to a condition where the cervix fails to maintain an intrauterine pregnancy until term (Ludmir 1988). Cervical insufficiency is characterized by painless dilation of the cervix followed by either the premature rupture or prolapse of the fetal membranes but without uterine contractions.