Transabdominal cervicoisthmic cerclage for the management of repetitive abortion and premature delivery.

The indications for a transabdominal approach for cervicoisthmic cerclage (TCIC) included traumatic laceration, congenital or surgical shortening of the cervix, previously failed transvaginal cerclage, and advanced cervical effacement with intact membranes. The frequency of all cerclage procedures was 1 in 260 deliveries; one TCIC was performed for each six vaginal procedures in the period from 1966 to 1980. A 0.5-cm Mersilene band was applied at the level of the anatomical internal os in an avascular space between branches of the uterine artery. Prior to this operation, the 16 patients had had 55 pregnancies (excluding first-trimester abortions) and had experienced 42 fetal losses (24% salvage rate). After TCIC, 22 pregnancies in 16 patients resulted in 19 term births, two premature births with favorable outcomes, and one fetal loss (95% salvage rate; chi 2 = 46.5, P less than 0.001). All infants were delivered by cesarean section. Postoperative morbidity and the incidence of premature labor or rupture of the membranes were low. Transabdominal cerclage is effective in selected patients with poor obstetric histories that show anatomically defective cervices, or when marked effacement has precluded high vaginal placement of the cerclage.