ABSTRACT:
Objective: To evaluate and describe our experience in the management of recurrent second trimester miscarriage and preterm delivery after the failure of transvaginal cervical cerclage by laparoscopic transabdominal cervicoisthmic cerclage (LTCC) during pregnancy – the new operative “Soo” procedure.

Materials and method: Forty five women in whom it was not technically possible to perform transvaginal cerclage were included in retrospective review. We divided two groups. First 20 patients were performed by traditional LTCC and second 25 patients underwent “Soo” procedure which is taped lateral to the uterine vessels. We evaluated pregnancy outcomes and fetal salvage rates between both groups.

Results: Mean gestational age at time of cerclage placement was 12.1weeks (range 11-14weeks). The Soo procedure’s operation time (40 min) is shorter than the traditional LTCC (50 min). Forty-three patients successfully delivered 49 live babies (6 sets of twins). Mean baby weight was 2590 gm in LTCC and 2640 gm in Soo procedure group. Two losses (one in LTCC, the other in Soo procedure) occurred after rupture of membrane at 19 and 20 weeks gestational age after cerclage. Comparison of live birth rates, gestational age at delivery, and mean birth weight showed no statistically difference between both groups. There was no operative or immediate postoperative complication. The major concern of “Soo” procedure is the effects on fetal development. We evaluated S/D ratio in umbilical artery Doppler velocimetry between Soo procedure and normal control in 30 to 34 gestational ages. The results showed that comparison of S/D ratio in both groups was not statistically different.

Conclusion: “Soo” procedure with needle inserted lateral to the uterine vessels is simpler than LTCC and does not influence fetal growth.