Effectiveness of laparoscopic abdominal cerclage on pregnancy outcome in women with cervical incompetence: An observational cohort study

Objective: To assess the successful pregnancy, preterm delivery and complications in patients with history of cervical insufficiency and failed vaginal cerclage who underwent laparoscopic abdominal cerclage (LAC). Methods: In a mixed cohort study, the recorded data of 170 eligible patients in medical documents and hospital records were extracted at Arash Hospital, Tehran, Iran during the March 2022 to March 2025, retrospectively and the treatment outcomes gathered by medical history and telephone interview, prospectively. LAC approach was done after general anesthesia for all patients. Of all included patients, 94 cases got pregnant and during study and after follow up, pregnancy outcomes occurrence after cerclage, gestational age <35 weeks and ≥36 weeks, complications and failed pregnancies were recorded as primary study outcome. Data analysis performed with SPSS version 24 software, using descriptive and analytic statistics. Results: 170 eligible women were included. Followed them during two years after operation, 94 women got pregnant. Of 94 pregnant women after LAC, 6 cases had unsuccessful pregnancy due to rupture of membranes, ectopic pregnancy, fetus heart abnormally, and intrauterine fetal death. Finally, from 81 mothers, 75 mothers had successful pregnancy and the LAC success rate of pregnancy was 92.6% and the incidence of delivery ≤35 weeks was 34%. Secondary infertility ( P =0.04), lower maternal’ age ( P =0.03), and higher body mass index ( P =0.04) were associated with successful pregnancy. Shorter interval from cerclage to conception was related to more term deliveries ( P =0.009) and successful pregnancy ( P <0.001). Conclusions: LAC could be considered as an effective treatment to preserving pregnancy and preventing the preterm delivery, in patients with cervical incompetence.