Laparoscopic cerclages placed before conception. (After Failed Transvaginal Cerclages).

SAN FRANCISCO -- Several case reports suggest that placing a cerclage via laparoscopy in the cervicoisthmic portion of the uterus before conception can help selected women with cervical incompetence safely carry a pregnancy to term, Dr. Bert Scoccia said at the annual meeting of the American Association of Gynecologic Laparoscopists.

The preconceptional cervicoisthmic cerclage is not a first-line intervention, because it commits the woman to delivering by C-section. It should be reserved for women who have lost several pregnancies despite transvaginally placed cerclages, he said.

Usually, women with repeated midtrimester pregnancy losses from cervical incompetence are given a transvaginal cerclage early in the second trimester of pregnancy. If that fails repeatedly, they may get a cervicoisthmic cerclage placed surgically via laparotomy either before conception or during the second trimester, requiring a C-section delivery.

The laparoscopic approach can be done on an outpatient basis and avoids the increased morbidity associated with laparotomy. Preconceptional placement avoids surgery during pregnancy, said Dr. Scoccia of the University of Illinois at Chicago.

He described one case of laparoscopic preconceptional cervicoisthmic

cerclage, one of only a few to be reported thus far.

The 28-year-old woman with a history of oligomenorrhea previously bore one child with the help of ovulation induction using clomiphene. Two more pregnancies following separate ovulation inductions resulted in first-trimester spontaneous abortions.