Transabdominal cerclage for fetal wastage due to cervical incompetence.

From 1978-1986, nine transabdominal cervicoisthmic cerclage procedures were performed on eight patients at the University of California, San Francisco. In six of the patients, the decision to perform the procedure was based on failed transvaginal cerclages. In five of these six cases, the cervix had deep traumatic defects. In the remaining two patients, the cervix was extremely short. Before the procedure, the eight patients had 25 pregnancies lasting beyond the first trimester, with 20 fetal losses (fetal salvage rate 20%). After the transabdominal procedure, the eight patients had 13 pregnancies resulting in eight term births, three premature births (at approximately 36 weeks' gestation), and two fetal losses (salvage rate 85%). All infants were delivered by cesarean section. The transabdominal cerclage may increase the fetal salvage rate in selected women when poor obstetric outcome is related to failed transvaginal cerclage and/or an anatomically defective cervix.