Cerclage 2: Abdominal vs Vaginal

Abstract

Cervical cerclage to prevent preterm labor in cervical incompetence is performed transvaginally or transabdominally, with the transvaginal method generally used. Transabdominal cerclage is a more invasive procedure than transvaginal cerclage and is performed in patients for whom transvaginal cerclage is difficult. It is recommended that the transvaginal procedure be performed at 12–14 weeks of pregnancy and that transabdominal cerclage be performed up to week 12. Although both procedures carry a risk of hemorrhage and premature rupture of the membranes, with transabdominal cerclage in particular there is a risk of problems such as adhesion formation resulting from repeated laparotomy. In managing postoperative care after both procedures, caution is exercised with respect to symptoms of threatened miscarriage or preterm labor. Although the suture is removed at 36–37 weeks of pregnancy with transvaginal cerclage, transabdominal cerclage requires laparotomy to remove the suture, and delivery is therefore performed by Cesarean section. It has been noted that, in patients with a disturbance of the vaginal flora, transvaginal cerclage may worsen local infection and increase the rate of preterm labor. Because transabdominal cerclage can be performed under sterile conditions, it may be useful in patients with local infection.