BACKGROUND AND PURPOSE:

• Bobotis et al. (AJOG, 2025) compared the impact of transvaginal and transabdominal cervical cerclage on obstetrical and perinatal outcomes in women at risk for preterm birth

METHODS:

• Systematic review and meta-analysis
• Inclusion criteria
  • Randomized and observational studies
  • Studies that assessed the impacts of different cervical cerclage surgical approaches on obstetrical and neonatal outcomes for women at risk of preterm birth
• Study design
  • The Risk of Bias was assessed
  • Quality of evidence was assessed with GRADE criteria
  • Pooled risk ratios were calculated using a random-effects model
• Primary outcomes
  • Perinatal mortality
  • Preterm birth

RESULTS:

• 12 studies | 1110 patients
  • History of TVC failure: 5 studies
  • History of cervical surgery (e.g., conization): 3 studies
• Transabdominal cerclage (both open and laparoscopic approaches) was associated with a lower rate of perinatal mortality than transvaginal cerclage
  • Risk ratio (RR) 0.36 (95% CI, 0.14 to 0.95)
  • I2=50% | 8 studies | 975 participants
  • Low-quality evidence
• The rate of preterm birth was also lower in the transabdominal cerclage group
  • RR 0.49 (95% CI, 0.25 to 0.94)
  • I2=73% | 8 studies | 932 participants
  • Low-quality evidence
• The rates of perinatal mortality and preterm birth were similar among patients who underwent open vs laparosopic transabdominal cerclage
  • Perinatal mortality
    • RR 1.24 (95% CI, 0.35 to 4.35)
    • I2=0% | 3 studies | 122 participants
  • Preterm birth
    • RR 1.23 (95% CI, 0.60 to 2.54)
    • I2=40% | 2 studies | 99 participants

CONCLUSION:

• Transabdominal cerclage is associated with reduced rates of perinatal mortality and preterm birth particularly among patients with previous transvaginal cerclage failure or surgically altered cervix  
• The authors state

Given the frequency of prematurity and the increased associated morbidity and mortality, TACs deserve further study as a potential therapeutic option for these patients

Learn More – Primary Sources:

Transabdominal vs transvaginal cervical cerclage in the prevention of preterm birth: a systematic review and meta-analysis