Application and timing selection of laparoscopic cervical cerclage in the treatment of patients with cervical insufficiency

Objective To explore the therapeutic effect and surgical timing selection of laparoscopic cervical cerclage in the treatment of patients with cervical insufficiency (CI).

Methods Clinical materials of 120 patients with CI in Northern Jiangsu People's Hospital from June 2019 to December 2022 were retrospectively analyzed. According to the different stages of pregnancy and surgical methods, the patients were divided into pre-pregnancy laparoscopy group (n=45), early pregnancy laparoscopy group (n=42) and transvaginal group (n=33, treated with vaginal cerclage). Indexes such as hospital stay, operation time, intraoperative bleeding volume and fetal protection rate during pregnancy were recorded. Follow-up was performed to collect information on patients'pregnancy outcomes, the pregnancy outcomes of the three groups were analyzed, and the surgical selection principles for different stages of pregnancy were summarized.

Results The intraoperative bleeding volume, hospital stay and fetal protection rate during pregnancy in the pre-pregnancy laparoscopy group and early pregnancy laparoscopy group were significantly lower than those in the transvaginal group (P < 0.01); there was no significant difference in operation time among the three groups (P>0.05). Compared with the transvaginal group, the abortion rate and premature birth rate in the pre-pregnancy laparoscopy group and early pregnancy laparoscopy group were significantly lower, while the full-term birth rate and gestational week at delivery were significantly higher (P < 0.05). The pre-pregnancy laparoscopy group had a significant lower premature birth rate compared to the early pregnancy laparoscopy group (P=0.044).

Conclusion Laparoscopic cervical cerclage can effectively improve the pregnancy outcomes of patients with CI, increase full-term birth rate and gestational week at delivery, and reduce abortion rate and premature birth rate. Pre-pregnancy laparoscopic cervical cerclage has slight advantages in reducing the premature birth rate and surgical risks.