Abstract
Objective
The aim of this meta-analysis was to compare the impact of transvaginal and transabdominal cervical cerclage on obstetrical and perinatal outcomes in women at risk for preterm birth.
Data Sources
PubMed, Scopus, and Web of Science electronic databases were screened up to January 2024.
Study Eligibility Criteria
Studies were included if they evaluated women at risk for preterm birth who underwent either a transvaginal or a transabdominal cervical cerclage. The meta-analysis included both randomized and observational studies that assessed the impact of different surgical approaches on obstetrical and neonatal outcomes.
Methods
Data extraction and quality assessment were performed in duplicates using the Risk of Bias 2 and Risk Of Bias In Non-randomized Studies of Interventions tools. The pooled risk ratios and 95% confidence intervals were calculated using a random-effects model.
Results
Our main analysis, which included 12 studies, showed that a transabdominal cerclage, which included both the open and laparoscopic approaches, was associated with a lower rate of perinatal mortality than a transvaginal cerclage (8 studies, 975 participants, risk ratio, 0.36; 95% confidence interval, 0.14–0.95; I2=50%; τ2=0.56). The rate of preterm birth was also lower in the transabdominal cerclage group than in the transvaginal cerclage group (8 studies, 932 participants, risk ratio, 0.49; 95% confidence interval, 0.25–0.94; I2=73%; τ2=0.36). The confidence in this meta-analysis was low according to the Grading of Recommendations, Assessment, Development, and Evaluations because of the presence of considerable heterogeneity. Our secondary analysis showed that the rate of perinatal mortality was similar among patients who underwent an open transabdominal cerclage and those who underwent a laparoscopic transabdominal cerclage (3 studies, 122 participants, risk ratio, 1.24; 95% confidence interval, 0.35–4.35; I2=0%; τ2=0). In addition, the rate of preterm birth was similar among patients who underwent an open transabdominal cerclage and those who underwent a laparoscopic transabdominal cerclage (2 studies, 99 participants, risk ratio, 1.23; 95% confidence interval, 0.60–2.54; I2=40%; τ2=0).
Conclusion
The results of this meta-analysis suggest that a transabdominal cerclage may have the potential to outperform a transvaginal cerclage in reducing perinatal mortality and preterm birth rates in patients at high risk for preterm birth, particularly those with a history of failed transvaginal cerclage or anatomic contraindications to vaginal placement. However, the data remain inconclusive considering the observational nature and heterogeneity of the included studies. Given the frequency of prematurity and the increased associated morbidity and mortality, a transabdominal cerclage deserves further study as a potential therapeutic option for these patients.