Pre-Pregnancy Transvaginal Double Cervico-Isthmic Cerclage To Treat Women With Previous Conventional Failed Cerclage For Cervical Insufficiency: A Novel Modification of Treatment

Objective: To report pregnancy outcome following a pre-pregnancy transvaginal cervico-isthmic cerclage using a double non-absorbable synthetic polyester thread in a population of high-risk pregnant women. Methods: A retrospective descriptive study with a continuous series of 76 women presenting with at least one prior prophylactic failure of McDonald cerclage and submitted a pre-gestational transvaginal cervico-isthmic cerclage by the same surgical team between 2010 and 2019. The pregnancy outcome was analyzed for the first subsequent pregnancy of 64 women. The main outcome measure was the overall survival rate. Results: The median age of the patients was 30 years (SD 4.9; range 19-45 years). No intra-operative complication occurred. The median operating time was 39.8 minutes (range 35.5-55.8 min). Cesarean delivery was systematically performed in all patients. The mean gestational age at delivery was 35.5 weeks (SD 5.67; range 16-39 weeks), term birth rate (≥37 weeks) was 64.1%; 84.4% of babies were delivered at ≥34.0 weeks gestation. The overall neonatal survival rate was 94%. Conclusion: The pre-conceptional transvaginal cervico-isthimic cerclage here described as Shirodkar-Barini surgery is safe and results in high percentage of live born babies and low prematurity rate on the following pregnancy, in the patients with heavy obstetrics past suggestive of cervical incompetence and previous prophylactic McDonald’s failure