Laparoscopic Cervical Cerclage

An incompetent cervix - a cause of recurrent miscarriages

An incompetent cervix, also called a cervical insufficiency, occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy.

Preventing a pregnancy loss in patients with an incompetent cervix

To prevent miscarriages that happen due to a 'weak' cervix, the aim is to 'strengthen' the cervix with artificial material like a nylon/mersilene tape. This procedure is known as a 'cervical cerclage'.

Cervical cerclage refers to a variety of procedures that use sutures or synthetic tape to reinforce the cervix during pregnancy in women with a history of a short cervix. The cervix is the lower part of the uterus that opens to the vagina.

Cervical cerclage can be done through the vagina (transvaginal cervical cerclage) or, less commonly, through the abdomen (transabdominal cervical cerclage). Transabdominal cervical cerclage is however now an outdated procedure, having being replaced by laparoscopic cervical cerclage.

Laparoscopic Cervical Cerclage

The Laparoscopic Cerclage is a surgical procedure to treat cervical insufficiency. A suture is placed around the cervix at its uppermost part near the transition with the uterine body. This level cannot be reached from the vagina hence the abdominal approach.

Cerclage, a purse string suture around the cervix, was initially proposed for the treatment of cervical insufficiency in the 1950s when the procedure was done accessing the cervix through the vagina.

The indications for Transabdominal Cerclage can vary, but it should be considered as an option in cases where:- 

  • There is a consistent history of Cervical Insufficiency, i.e., cervical dilatation and subsequent fetal loss or premature delivery in the absence of uterine contractions.

  • A Transvaginal Cerclage done in a previous pregnancy has failed.

  • The cervix is short or very irregular, usually after surgical procedures such as trachelectomies or cone biopsies and/or previous transvaginal cerclages.