Experience of laparoscopic transabdominal cerclage for the correction of cervical insufficiency during pregnancy: a clinical case and literature review
https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.578
Abstract
Miscarriage remains one of the most pressing challenges in modern obstetric practice, markedly impacting birth rates and women’s health. One of the manageable miscarriage causes is presented by cervical insufficiency (CI) occurring in 0.2–2.0 % of all pregnant women and in 15.5–42.7 % of those with habitual miscarriage. Both conservative and surgical treatments, such as the use of obstetric pessaries or cerclage, are applied to prevent CI-related preterm birth. Transvaginal cerclage remains the most common procedure for CI correction. However, in certain situations, transvaginal cerclage may be inapplicable or ineffective due to prior cervical scarring, conization, or other anatomical alterations. In such cases, transabdominal cerclage (TAC) can be considered as an alternative. TAC, either performed via laparotomy or laparoscopy, has demonstrated successful pregnancy outcomes in 81–89 % of cases. This article provides a brief literature review on CI surgical treatment and presents a clinical case of successful pregnancy after laparoscopic TAC. The patient, with a history of severe cervical pathology and multiple pregnancy losses, underwent a laparoscopic TAC at 13 weeks and 3 days of gestational age using the Cervix-set tape. The pregnancy was carried to term, and a healthy baby was delivered via planned cesarean section at gestational age of 38 weeks. Thus, laparoscopic TAC is an effective alternative for patients with complex cervical anatomy requiring more advanced surgical intervention. This procedure achieves high success rates for prolonging pregnancy and ensuring favorable outcomes while minimizing risks for both mother and child.
Keywords
pregnancy loss,
recurrent miscarriage,
cervical insufficiency,
CI,
surgical correction,
transabdominal cerclage,
TАC,
laparoscopic cerclage
Supporting agencies: The work was carried out as part of the implementation of the Program for supporting scientific studies and experimental development of students, postgraduates and persons with academic degree, funded by the Government of the Republic of Karelia.
About the Authors
A. A. Ivshin
Petrozavodsk State University
Russian Federation
Russian Federation
Alexandr A. Ivshin, MD, PhD.
Scopus Author ID: 610777
WоS ResearcherID: AAG-1507-2020
33 Lenin Avenue, Petrozavodsk 185910
O. O. Pogodin
Gutkin К.А. Republican Perinatal Center, Ministry of Health of the Republic of Karelia
Russian Federation
Russian Federation
Oleg O. Pogodin, MD.
9 Syktyvkarskaya Str., Petrozavodsk 185002
E. Yu. Shakurova
Gutkin К.А. Republican Perinatal Center, Ministry of Health of the Republic of Karelia
Russian Federation
Russian Federation
Elena Yu. Shakurova, MD, PhD.
9 Syktyvkarskaya Str., Petrozavodsk 185002
T. Yu. Ldinina
Gutkin К.А. Republican Perinatal Center, Ministry of Health of the Republic of Karelia
Russian Federation
Russian Federation
Tatiana Yu. Ldinina, MD.
9 Syktyvkarskaya Str., Petrozavodsk 185002
V. S. Nikitin
Petrozavodsk State University
Russian Federation
Russian Federation
Vadim S. Nikitin
33 Lenin Avenue, Petrozavodsk 185910
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What is already known about this subject?
► Cervical insufficiency (CI) is one of the leading causes of pregnancy loss and is diagnosed in a substantial percentage of women with habitual miscarriage.
► Transvaginal cerclage is the most commonly used surgical method for correcting CI but is ineffective in case of cervical anatomical changes such as scarring or conization. Transabdominal cerclage (TAC) is considered an alternative for such complex cases and can be performed via laparotomy or laparoscopy, showing high success rates for prolonging pregnancy.
What are the new findings?
► This article describes a successful case of in-pregnancy laparoscopic TAC underlining its effectiveness in cases of severe cervical pathology. It presents a TAC clinical case using the Cervix-set tape at 13 weeks of gestational age demonstrating successful pregnancy continuation and birth of a healthy baby. The article emphasizes the advantages of laparoscopic TAC as a minimally invasive method that lowers surgical risks and improves chances of successful delivery in complex clinical cases.
How might it impact on clinical practice in the foreseeable future?
► The use of laparoscopic TAC could become a more widely accepted approach for treating CI in patients with severe cervical anatomical alterations, increasing the chances of successful pregnancy continuation. The minimally invasive nature of the laparoscopic procedure promotes faster recovery and lowers a risk of postoperative complications, making it a preferred option in complex clinical cases.
► The successful clinical case and literature review may encourage clinicians to consider broader use of this technique in specialized medical centers. In the long term, laparoscopic TAC could reduce the incidence of preterm births and perinatal losses in CI patients, improving overall reproductive outcomes.
Review
For citations:
Ivshin A.A., Pogodin O.O., Shakurova E.Yu., Ldinina T.Yu., Nikitin V.S. Experience of laparoscopic transabdominal cerclage for the correction of cervical insufficiency during pregnancy: a clinical case and literature review. Obstetrics, Gynecology and Reproduction. 2025;19(1):116-126. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2025.578
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