Abdominal Cerclage

Introduction: Cervical insufficiency is a significant cause of recurrent second-trimester pregnancy loss and preterm birth. In cases where vaginal cerclage (e.g., McDonald or Shirodkar techniques) fails or is not feasible, such as after significant cervical trauma or conization, abdominal cerclage emerges as an alternative. However, the need for repeat laparotomy to remove the suture remains a major limitation. The aim of this article was to introduce and describe a modified transabdominal cerclage technique that allows for transvaginal suture removal, aiming to reduce secondary surgical interventions and improve maternal outcomes as a Sarem Novel Technique in Sarem Women Hospital at Tehran.

Method: The procedure is performed via laparotomy in the late first or early second trimester, after initial fetal assessment. Following the dissection of the bladder peritoneum and opening of the posterior cul-de-sac, a Mersilene tape is placed at the level of the internal os, passing once through the right and once through the left lateral cervix. The suture is then tied posteriorly and directed into the rectovaginal space via the opened peritoneum, enabling potential removal through a minor posterior vaginal incision, if needed.

Results: Our experience in a specialized center suggests that this technique is relatively easy to perform, reduces the need for repeat laparotomy, and enables safe suture removal when indicated. The risk of uterine artery injury is minimized, and uterine contractions are managed pharmacologically during and after the procedure.

Conclusion: This modified abdominal cerclage technique with the option of transvaginal removal offers a safe, effective, and less invasive alternative for selected cases of cervical insufficiency, potentially reducing surgical burden and improving patient outcomes.