Laparoscopic cervicoisthmic cerclage in pregnancy.(Obstetrics)

UNIVERSAL CITY, CALIF. -- A significant number of successful deliveries have occurred, and one patient has delivered two babies, following laparoscopic cervicoisthmic cerclage performed during pregnancy at the University of Illinois, Chicago.

Andrew I. Brill, M.D., professor of ob.gyn. and director of gynecologic endoscopy at the university, reported on more than a dozen cases at the annual meeting of the Obstetrical and Gynecological Assembly of Southern California.

The innovative laparoscopic procedure could offer hope of a minimally invasive alternative to a technically demanding and often complicated abdominal surgery during pregnancy, in patients for whom conventional vaginal cerclage has failed or is not possible.

"These are patients who are quite desperate, with a history of multiple losses despite repeated conventional procedures," Dr. Brill said.

All the patients in his series had experienced failure of conventional vaginal cerclages for cervical incompetence, and many had suffered repeated second-trimester losses. In some patients, previous cervical procedures precluded placement of a vaginal cerclage.

If such patients desire children, "There really is no salvation but abdominal cervicoisthmic cerclage," he explained.

Conventional abdominal cerclage typically requires an extended midline abdominal incision and a considerable hospital stay. Complications can include hemorrhage and pregnancy loss. Laparoscopic cervicoisthmic cerclage during pregnancy is a novel and technically challenging procedure. Ideally, it should be performed by 12 weeks' gestation, at a point when the risk of spontaneous first trimester loss is minimal but there is still enough space to safely manipulate and work around the gravid uterus, according to Dr. Brill.