Laparoscopic Cerclage Placement for Cervical Incompetence  

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Laparoscopic cerclage placement for cervical incompetence

Cervical incompetence is one of the causes of preterm delivery and pregnancy loss. In some women, the cervix opens prematurely and the typical scenario involves painless dilatation of the cervix in the second trimester (often around 16-18 weeks). This then leads to premature rupture of membranes and loss of the pregnancy, often before viability. A cerclage is basically a suture that is tied around the cervix in order to prevent it from opening too soon. The traditional cerclage is placed through the vagina and this is often done at around 12-14 weeks of pregnancy. The vaginal cerclage can be effective, but unfortunately does not always help. In the setting of a failed vaginal cerclage, it has been well demonstrated that an abdominal cerclage is more effective. This used to be placed through a large incision, but a laparoscopic cerclage is just as effective and has the advantage of allowing patients a quick (one week vs. 8 weeks with a large incision) recovery. Dr. Einarsson has performed approximately 200 laparoscopic cerclage procedures, which is one of the largest series of this procedure in the United States. In his most recent publication from his data, the efficacy of the laparoscopic cerclage was about 97%. Many of these patients had endured multiple losses prior to this procedure. The laparoscopic cerclage is generally placed prior to pregnancy, but can also be placed during the first trimester of pregnancy. It is recommended that patients wait 2 months to get pregnant after placement and the mode of delivery will have to be a cesarean section. If a miscarriage occurs, then evacuation can still be done with the cerclage in place. Patients do need frequent surveillance by an expert in high risk obstetrics during their pregnancy. If the cerclage looks good at the time of the cesarean section, it can be left in place to be utilized in future pregnancies. It is not necessary to remove it even if the patient is not planning to have more children.

Video from Laparoscopic cerclage

Warning: The video on hysterectomy provides a detailed and graphic insight into the surgical procedure, intended for mature audiences due to its explicit content and medical nature.

Important information about the procedure

Laparoscopic cerclage is a minimally invasive surgical procedure that involves placing a stitch around the cervix to help prevent premature delivery in women who have a history of cervical incompetence. It is typically performed under general anesthesia and usually takes around 1 hour to complete. 

 During the procedure, the surgeon will make several small incisions in the abdomen and insert a laparoscope, which is a thin tube with a camera attached to it. This allows the surgeon to see inside the abdomen and guide the surgical instruments. 

 The surgeon will then use specialized instruments to place a stitch around the cervix to help hold it closed and prevent premature dilation. This stitch is typically made of a strong, non-absorbable material that can remain in place for the duration of the pregnancy. 

It is important to discuss the risks and benefits of laparoscopic cerclage with your surgeon before the procedure and to carefully follow their instructions for post-operative care to minimize the risk of complications. 


Potential complications of laparoscopic cerclage include:

There is a risk of bleeding during and after the surgery, which may require blood transfusions or additional surgery. 

There is a risk of infection at the incision sites or within the abdomen, which may require antibiotics. 

There is a small risk of injury to nearby organs such as the bladder, bowel, or ureter during the surgery, which may require additional surgery to repair. 


There is a small risk that the stitch may cause premature rupture of the amniotic sac, leading to premature delivery. This applies only if the cerclage is placed during pregnancy. 

In some cases, the stitch may not be effective in preventing premature delivery, and premature labor may still occur. 

There is a risk of developing blood clots in the legs or lungs after the surgery, which can be prevented with medication and early mobilization. 

Laparoscopic cerclage placement for cervical incompetence