Objective: This study aimed to evaluate whether laparoscopic abdominal cerclage (LAC) or transvaginal cerclage (TVC) is more effective in prolonging gestation among patients with cervical cicatricial deformity. Methods: Data were retrospectively collected from pregnant women with cervical cicatricial deformity who underwent cerclage between January 2017 and October 2024. Pregnancy and neonatal outcomes were compared between the LAC and TVC groups. Continuous variables were analyzed using Student’s t tests or Mann–Whitney U tests; categorical variables were compared using Chi-square or Fisher’s exact tests, as appropriate. To address potential confounding, a multivariable logistic regression model was constructed to identify independent risk factors for spontaneous preterm birth before 34 weeks. Kaplan–Meier analysis with log-rank testing was performed to compare rates of delivery before 34 weeks between groups. Results: A total of 90 patients were enrolled, including 29 in the LAC group and 61 in the TVC group. No significant difference was observed in median gestational age at delivery between groups ( P = 0.276). The LAC group demonstrated significantly longer cerclage retention (171.21 ± 39.98 vs. 126.75 ± 44.39 days, P < 0.001) and lower rates of delivery before 34 weeks (6.90% vs. 37.70%, P = 0.002), post-cerclage reproductive tract infection (3.45% vs. 45.90%, P < 0.001), and preterm prelabor rupture of membranes (3.45% vs. 32.79%, P = 0.002). In adjusted analyses, TVC remained an independent risk factor for delivery before 34 weeks (adjusted odds ratio = 8.62; 95% confidence interval: 1.2061.85; P = 0.032). Neonatal outcomes were also more favorable in the LAC group, with lower rates of neonatal intensive care unit admission (17.86% vs. 55.36%, P = 0.001) and low birth weight infants (6.90% vs. 39.34%, P = 0.002). Conclusion: LAC may represent a preferable surgical approach for managing cervical incompetence in the presence of cicatricial deformity.
Qi et al. (Thu,) studied this question.