Pre-conceptional laparoscopic cerclage for prevention of preterm birth: a systematic review.

Background: Cervical cerclage is used to prevent preterm delivery caused by cervical insufficiency, thereby reducing neonatal morbidity and mortality rates. Transabdominal cerclage is usually performed in women who previously underwent transvaginal cerclage that failed to prevent pregnancy loss, or in those with a short cervix where transvaginal cerclage was not feasible.

Objectives: To estimate the efficacy of pre-conceptional laparoscopic cerclage in facilitating term delivery and live birth.

Methods: A systematic review was conducted according to the PRISMA 2020 guidelines. This study was registered in PROSPERO (CRD42024545316). A search was conducted up to the 15th of April 2024, in the PubMed and Cochrane databases, using a combination of terms "laparoscopy", "transabdominal" and "cerclage". Original studies investigating the role of pre-conceptional laparoscopic cerclage on pregnancy outcomes after follow-up were eligible for inclusion in this review.

Main outcomes measures: Prevalence of deliveries after 37 weeks of gestation and live birth rates.

Results: Ten studies involving 1060 patients were included. The pooled prevalence of deliveries after 37 weeks of pregnancy was 70% [95% confidence interval (CI) 60%-79%, 7 studies, 515 pregnancies, I2: 85%] and the pooled prevalence of live birth was 92% (95% CI 86%-95%, 10 studies, 713 pregnancies, I2: 69%). Significantly higher rates of delivery after 37 weeks of pregnancy were associated with the use of mersilene tape compared to conventional sutures [odds ratio (OR): 2.98, 95% 1.95-4.56] and the use of an anterior knot compared to a posterior knot (OR: 2.26, 95% CI: 1.50-3.40).

Conclusions: Pre-conceptional laparoscopic cerclage achieved high rates of live birth after 37 weeks in women considered at high risk of preterm delivery. Comparative research is needed to better understand the efficacy of pre-conceptional laparoscopic cerclage as well as refine the indications for this procedure, optimise surgical techniques, and determine the best timing for cerclage placement.

What is new?: Pre-conceptional laparoscopic cerclage may prevent future preterm births and second-trimester pregnancy losses.