The Role of Abdominal Cerclage in Managing Multiple Pregnancy Losses. Case Report

Cervical incompetence is a recognized cause of recurrent pregnancy losses in the second trimester. Abdominal cerclage, a less common surgical technique than transvaginal cerclage, may be a viable option in cases where transvaginal procedures have failed or are contraindicated. This report describes the case of a 34-year-old patient with severe cervical incompetence, characterized by recurrent pregnancy losses in the second trimester, despite having undergone multiple transvaginal cerclages without success. It was decided to perform an abdominal cerclage by laparotomy, with the placement of a permanent suture around the upper portion of the cervix, at the transition to the uterine isthmus. A direct comparative intervention was not performed, as previous attempts with transvaginal cerclage were unsuccessful. However, a theoretical comparison with transvaginal techniques is addressed in terms of efficacy and safety. The intervention allowed the patient to carry a pregnancy to term, culminating in a cesarean delivery without significant obstetric complications. Postoperative follow-up revealed no complications derived from the abdominal cerclage. Abdominal cerclage proved to be an effective therapeutic option in this patient with severe cervical incompetence, where transvaginal methods had failed. This case highlights the importance of considering abdominal cerclage in patients with refractory cervical incompetence, highlighting its potential to achieve successful pregnancies