Cervical insufficiency
When a vaginal cerclage was not enough.
An abdominal cerclage is a permanent stitch placed at the top of the cervix from inside the abdomen — where it can hold when a stitch placed from below could not.
What the evidence shows
A vaginal cerclage is placed low on the cervix and needs enough cervical tissue to hold. An abdominal cerclage sits at the junction of the cervix and uterus, above the vagina. In the MAVRIC randomized trial of women whose previous vaginal cerclage had failed, delivery before 32 weeks occurred in 8% of those given an abdominal cerclage versus 33% with a low vaginal cerclage (3 of 39 vs 11 of 33). In an exploratory analysis, fetal loss occurred in 3% (1 of 39) versus 21% (7 of 33). That is one trial in a selected group; individual results vary.
Source: Shennan A, et al. MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage. Am J Obstet Gynecol. 2020;222(3):261.e1–261.e9. doi:10.1016/j.ajog.2019.09.040
How the decision is made
Candidacy, timing (before conception or in early pregnancy) and the surgical approach are decided at the consult, with your maternal-fetal medicine specialist involved in the pregnancy plan. The stitch is permanent, delivery is by cesarean, and the cerclage can serve future pregnancies. The added surgical risk compared with a vaginal cerclage is part of that discussion.
Dr. Weiss performs abdominal cerclage with robot-assisted laparoscopy only, either before conception or during early pregnancy, at Memorial Regional Hospital and Memorial Hospital Miramar. When the pregnancy calls for it, care is shared with a maternal-fetal medicine specialist. He performs about ten abdominal cerclages a year. CONFIRM: latest gestational age accepted for placement during pregnancy.
FAQ
Abdominal cerclage questions
Who is a candidate for abdominal cerclage?
Women with cervical insufficiency whose vaginal cerclage did not prevent a loss or very early delivery, or whose cervix is too short or scarred for a vaginal stitch — for example after a trachelectomy or extensive cone biopsy. Candidacy is decided individually, usually together with a maternal-fetal medicine specialist.
When is it placed — before or during pregnancy?
Either. Placing it before conception is technically simpler. It can also be placed in early pregnancy, generally before 14 weeks. The timing is part of the consult.
Is it minimally invasive?
Yes. Dr. Weiss places abdominal cerclages with robot-assisted laparoscopy, through small incisions, both before pregnancy and during early pregnancy. He does not perform the operation through an open incision.
How will I deliver?
By cesarean section. The stitch stays in place and can support future pregnancies.
What are the risks?
Abdominal cerclage is major surgery with more morbidity than a vaginal cerclage: bleeding, infection, injury to nearby organs, and the need for cesarean delivery. These are weighed against the benefit for each patient.
I live out of state. How does this work?
Patients do travel for this operation. Call the office to discuss records review and a first visit; an initial telehealth consultation is available for patients who live at a distance.