Design: Retrospective Cohort Study

Setting: Patients underwent surgeries by a single surgeon at three tertiary care hospitals within a single hospital system between 1/1/2008-12/31/2023.

Patients or Participants: 107 patients underwent laparoscopy with intention for abdominal cerclage placement due to history of cervical insufficiency or difficult cervical anatomy due to prior surgery. The patients were either pre-conceptional or gravid with a singleton pregnancy. 35 patients were excluded from preliminary analysis due to incomplete data (9/107), no subsequent pregnancy (16/107), or SAB < 10weeks/elective termination (10/107). Of the eligible 72 patients, 39 underwent interval and 33 underwent gravid cerclage.

Interventions: N/A

Measurements and Main Results: There was no statistically significant difference between interval and gravid groups for primary fetal outcomes including live birth (37/39, 95% vs 31/33, 94%; RR 1.08), neonatal survival at hospital discharge (35/39, 90% vs 31/33, 94%; RR 0.79), delivery >34w (29/39, 74% vs 26/33, 79%; RR 0.89), gestational age at delivery (average 34.0 vs 34.6 weeks), fetal weight (average 2647g vs 2817g), all p>0.05. Secondary pregnancy outcomes were also not statistically different including PPROM (6/39, 15% vs 3/33, 9%; RR 1.27) and preterm labor (8/39, 20% vs 2/33, 6%; RR 1.6), both p>0.05. Surgical outcomes did not differ with regards to average blood loss (37cc vs 61cc) and average operative time (104 vs 104 minutes), both p>0.05.

Conclusion: With regards to optimal timing of laparoscopic abdominal cerclage placement, patients may be counseled that there is no difference in birth, pregnancy, or surgical outcomes between the interval and gravid time periods. Notably, however, 29% of interval group patients did not or were unable to become pregnant following the procedure.