Abstract / Summary
Transvaginal cerclage (TVC) is a common treatment for women with cervical incompetence (CI), but some patients still had spontaneous losses or preterm birth. For these patients, the optimal management strategy in subsequent pregnancies remains debated. This study aimed to compare the effectiveness and safety of preconceptional laparoscopic abdominal cerclage (LAC) versus repeat prophylactic TVC in improving gestational age at delivery and neonatal outcomes for patients who had prior TVC failure(s). This retrospective cohort study evaluated CI patients who had a history of failed prophylactic TVC (defined as delivery at < 28 weeks of gestation) and were treated at the First Affiliated Hospital of Zhengzhou University between July 2014 and December 2023. Patients underwent either preconceptional LAC or repeat prophylactic TVC. The primary outcome was the rate of delivery at gestational age (GA) ≥ 34 weeks. Secondary outcomes included perioperative metrics, pregnancy complications, and neonatal survival. Logistic regression was used to analyze the influencing factors of pregnancy < 34 weeks. There were 37 patients with preconceptional LAC (LAC group), and 35 patients with TVC (TVC group) included in the study. The LAC group demonstrated significantly reduced duration of hospitalization compared to TVC group ( P < 0.001), with no complications occurring in the LAC group. The median gestational age (GA) at delivery was significantly prolonged in the LAC group 38.00 (37.29, 38.57) weeks compared to the TVC group [32.71 (24.86, 37.93) weeks, P < 0.001]. There were 36 patients (97.30%) delivered at GA of ≥ 34 weeks, and 33 patients (89.19%) at GA of ≥ 37 weeks in the LAC group, which were significantly higher than those in the TVC group (42.86% and 31.43%, respectively, all P < 0.001). The LAC group exhibited a 97.37% of fetal survival rate, contrasting sharply with 58.33% in TVC group ( P < 0.001). Logistic regression analysis showed that LAC was a protective factor of delivery after 34 weeks of gestation (OR = 0.021, 95% CI: 0.003–0.170, P < 0.001). For patients with prior TVC failure, preconceptional LAC can serve as a preferable therapeutic option. Preconceptional LAC provides significantly better structural support for pregnancy maintenance and improves neonatal outcome compared to repeat prophylactic TVC, showing prolonged GA and high fetal survival rate.