BACKGROUND
Transabdominal cerclage has been used, since its description in 1965, for cervical incompetence and to maintain cervical closure in a few other conditions. Indications described have included failure of transvaginal cerclage in a prior pregnancy, cervical incompetence (by history) in a patient with severe cervical shortening (or deep laceration) and isolated severe cervical shortening. The procedure has principally been performed by placing a band between the uterine opening and cervix. Efficacy, compared to transvaginal cerclage, has not been demonstrated by prospective trials, but sequential pregnancy outcome analysis in patients previously treated with transvaginal cerclage is highly suggestive of its superiority in selected patients.

Barriers to use of this procedure include technical difficulty and operator experience, risk of hemorrhage and the need for both laparotomy (abdominal surgery) and cesarean in the same pregnancy. Another factor is the fairly widespread acceptance of transvaginal cerclage for years before the transabdominal approach came on the clinical scene.

We have had the opportunity to observe the clinical course of a fairly large number of patients selected to have transabdominal cerclage. The variability of patient selection and surgical technique has been limited in this series because care of all patients was under a single obstetrical surgeon. The size of this experience allows inspection for risks and outcomes in subsets of clinical presentations.