A recent study conducted by researchers at Mass General Brigham provides significant insights into the prevention of preterm births amongst patients with cervical insufficiency. The findings suggest that employing a transabdominal cerclage—where the cervical stitch is placed higher in the abdomen—can lead to a remarkable 70% reduction in the risk of delivering before 34 weeks of gestation, compared to the traditional transvaginal cerclage technique, where the stitch is placed vaginally. These results were highlighted in a publication in The American Journal of Obstetrics and Gynecology (AJOG).
“Our goal is to ensure a healthy pregnancy and safe delivery for every patient who comes to the hospital. We have data from a previous clinical trial that shows it’s important to choose the right surgical technique to help patients who are at very high risk for recurrent preterm birth. Our study suggests that finding translates to a population of slightly lower-risk women, who are sometimes offered these interventions,” stated Dr. Chelsea J. Messinger, MD, PhD, the lead author from the Department of Anesthesiology at Mass General Brigham.
The research team analyzed cases at Brigham and Women’s Hospital (BWH), a key institution within the Mass General Brigham healthcare system that facilitates around 6,200 births annually. This study involved two groups of singleton pregnancies between January 1, 2001, and February 28, 2021. The total number of participants was 188, with 87 receiving a transabdominal cerclage (TAC) and 101 undergoing a transvaginal cerclage (TVC). Notably, 86 out of 87 TAC procedures were executed using a minimally invasive approach.
Upon adjusting for various biases, the findings indicated that only 5.5% of patients with TAC experienced preterm birth, in stark contrast to 18.7% in the TVC group. Complications from the cerclage procedures were infrequent, with some cases of uterine perforation and rupture noted among TAC patients. Moreover, earlier research, such as the Multicentre Abdominal vs. Vaginal Randomised Intervention of Cerclage (MAVRIC) trial, corroborated similar outcomes, seeing a 77% reduction in preterm birth risk with TAC.
Importance of Shared Decision-Making
While these findings offer promising implications for managing pregnancies affected by cervical insufficiency, the researchers stress the need for comprehensive discussions between patients and healthcare providers. This dialogue should address the most suitable intervention tailored to individual patient needs, weighing the benefits of TAC against the risks of abdominal surgery and potential Cesarean delivery, particularly in cases where patients may have fewer factors contributing to the risk of preterm birth.
Source:
Journal reference:
Messinger, C. et al. (2025) Effect of transabdominal versus transvaginal cerclage on preterm birth and neonatal outcomes among patients with history of cervical insufficiency. The American Journal of Obstetrics and Gynecology (AJOG). doi.org/10.1016/j.ajog.2025.06.049.
