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Foetal growth restriction (FGR) is associated with neonatal morbidity, suboptimal neurodevelopmental outcomes and chronic diseases. Successful pregnancies of women with recurrent mid-trimester pregnancy losses may still be at risk of FGR and small for gestational age (SGA) outcomes. This study aimed to investigate whether patients with recurrent mid-trimester pregnancy losses who undergo transabdominal cerclage (TAC) are at an increased risk of FGR. Due to a paucity of information in this regard, and to inform accurate counselling, we performed a secondary analysis of a unique set of patients with a TAC procedure. Foetal growth restriction (<3rd centile) was present in 8% of cases, with more female than male babies falling in this category (9.2 vs. 7.4%). When combined, FGR plus SGA were present in 19.4% of cases. This rate is not higher than the expected population rate of around 20% in low- and middle-income countries.

The object of this study was to describe pregnancy outcomes in women who had a transabdominal cerclage (TAC) placed after a prior uterine incision due to caesarean section or hysterotomy. This is a retrospective observational study of 57 women referred to a maternal-fetal medicine specialist (JES) for TAC placement after a previous uterine incision from 1989-2012. Pregnancy outcomes post-TAC placement are reported, including gestational age at delivery, survival rate and complications directly related to labour and the previous uterine scar. Of 51 women who had a prior uterine incision and were pregnant at TAC, 49 (96.1%) delivered viable infants at a mean gestational age of 35.9 weeks. One patient had intrauterine fetal demise at 16 weeks for causes likely unrelated to TAC and another had uterine rupture associated with a unicornuate uterus and advancing labour at 31 weeks. This study includes women with low transverse incisions, classical uterine incisions and higher order multiples. It was concluded that in women with a prior uterine incision, placement of a TAC is associated with low risk (2%) of uterine rupture.

This retrospective cohort study identifies complications associated with transabdominal cerclage (TAC). In 300 procedures performed over a 24 year time span, 11 (3.7%) surgical complications were encountered. Fetal loss (prior to 20 weeks) occurred in 4.1% of pregnancies. The median estimated blood loss among patients was 100 ml, with blood loss sufficient to require transfusion only once. Considering patients with classical indications, the gestational age at delivery was greater (37 weeks) after TAC than in the latest pre-TAC pregnancy (24 weeks) (p < 0.001). Lower uterine dehiscence in four patients and uterine rupture in one, underscore the advisability of early term delivery after fetal lung maturity is assured. A survival rate of 98.0% was calculated among infants that were delivered at >24 weeks' gestation. Our results demonstrate that complications encountered in placing a TAC were unusual and generally manageable. This communication may assist the surgeon to balance risks in individual clinical circumstances more adequately.

Fifty patients with cervical incompetence were randomised to have cervical cerclage either as inpatients, spending 3 days in hospital post-procedure on supervised bed rest or as outpatients spending the time at home on bed rest. Both groups had a clinical diagnosis of cervical incompetence and both had either McDonald or Shirodkar cerclage with mersilene tape. Both groups were given salbutamol tablets for tocolysis, postoperatively. There were no significant difference in the demographic variables between the groups such as previous cerclage, gestational age at insertion, parity and gestational age at delivery. There were also no significant differences in early complications such as bleeding. Most late complications were also not different, including the spontaneous abortion rate, premature rupture of membranes, cervical dystocia and preterm delivery. However, more patients in the outpatient group had premature contractions (26.1% vs. 4.3% P=0.0479). More patients in the inpatient group had a delivery of a live neonate, 86.9% vs. 78.3%, but the difference was not statistically significant. In conclusion, out patient cerclage appears to be a valid option, the higher rate of premature contraction in this group is not a cause for concern in view of the similar mean gestational age at delivery.

A retrospective review was conducted on patients who had cervical cerclage performed because of suspected cervical incompetence over a 7-year period to assess the outcome of pregnancy and complications resulting from the cerclage. Other factors that could affect the outcome and complications were also assessed. Out of 196 patients who had the operation, 154 patients had adequate records available and therefore comprised the study population. There were 139 (90%) live births of which 76.6% weighed more than 2000 g. The outcome was not influenced by the experience of the surgeon, type of cerclage or the use of prophylactic antibiotics. There were no complications in 138 (90%) of the cases, and no cases of ruptured uterus, cervical lacerations and severe infections were encountered. The complications were seen more in multiple-order pregnancy and when the operation was performed as an emergency. The future role of cervical cerclage in the management of cervical incompetence in our community is discussed.