Focus of the Report: The use of transabdominal cervical cerclage (TAC) for treatment of cervical insufficiency to prevent preterm delivery (PTD) or miscarriage.

Technology Description: TAC involves the placement of sutures to reinforce the cervix using a transabdominal approach. An alternative to transvaginal cerclage (TVC), the procedure can be performed via laparotomy or laparoscopy prior to conception or during the first or early second trimester. TAC procedures allow for placement of the suture at a higher level in the cervix compared with TVC, i.e., at the level of the internal os.

Controversy: TAC is an invasive procedure that should be used cautiously among carefully selected patients who are not candidates for less invasive procedures, such as TVC. Complications associated with TAC may include excessive bleeding, infection, peripheral organ damage, or pregnancy loss. Laparoscopic procedures are a less invasive alternative to open procedures, although specialized training and equipment are required. Additional controversies related to TAC include whether the procedure should be provided prophylactically (before conception and prior to pregnancy) or therapeutically (during pregnancy) and whether the procedure is appropriate for use during a multi-fetal gestation.

Key Questions:

  • Is TAC effective for preventing PTD or miscarriage in women with cervical insufficiency or conditions that preclude TVC?

  • How does TAC compare with alternative methods for prevention of PTD or miscarriage?

  • Is TAC safe for treatment of cervical insufficiency and prevention of PTD or miscarriage?

  • Have definitive patient selection criteria been identified for TAC for prevention of PTD or miscarriage?

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