3D printed model of a uterus

Laparoscopic Transabdominal Cerclage

Laparoscopic transabdominal cerclage is a minimally invasive operation to place a strong stitch around the cervix from the abdomen, at the junction of the cervix and the lower uterus. It supports the cervix to reduce the risk of pregnancy loss or very preterm birth due to cervical insufficiency (sometimes called an “incompetent cervix”).

It is an alternative to — or a next step after — transvaginal cerclage, when the anatomy or past history means a vaginal stitch is not ideal or has failed before.

The decision is always individual and based on your history, examination, and sometimes imaging. Laparoscopic transabdominal cerclage may be discussed when:

  • You have had a second-trimester loss or very preterm birth thought to be due to cervical insufficiency
  • A previous transvaginal cerclage did not prevent preterm birth, or could not be placed safely
  • The cervix is very short, scarred, or surgically altered (for example after a procedure for cervical pre-cancer), making a vaginal cerclage difficult
  • You have a uterine anomaly or other factors that change how the cervix behaves in pregnancy

Not everyone with a difficult pregnancy history needs this procedure. I will review your records, talk through risks and benefits, and outline alternatives (including close surveillance without cerclage, or vaginal cerclage where appropriate).

How is the surgery performed?

The operation is done under general anaesthesia using laparoscopy (keyhole surgery). Small incisions are made on the abdomen, and a camera and fine instruments are used to place a tape or suture around the upper cervix at the level where it joins the uterus.

The stitch stays in place for future pregnancies unless there is a specific reason to remove it. Because it is placed abdominally, future births are almost always by planned caesarean section — vaginal birth is not advised with a transabdominal cerclage in situ.

Cerclage can be placed before you conceive (interval cerclage) or in early pregnancy, depending on your situation and what you and your maternity team prefer.

Recovery

Recovery is similar to other small laparoscopic gynaecological procedures:

  • You will go home the same day of surgery.
  • Mild shoulder-tip pain or bloating from the gas used for laparoscopy, usually settling in a day or two
  • Pelvic cramping or light bleeding for a short period
  • Most people resume light daily activities within 1 week, with a gradual return to exercise over 3–4 weeks

Read more in my Surgical Recovery Toolkit.

Risks and limitations

As with any surgery, there are risks such as bleeding, infection, injury to nearby structures, or the need to convert to open surgery (uncommon). There is also a small risk that the cerclage does not prevent preterm birth in every case.

Cerclage does not treat all causes of preterm labour (for example infection or placental problems). Care in pregnancy usually involves your obstetric team as well, with a clear plan for timing of delivery.

Dr Sam Holford

Planning your pregnancy

If you are worried about cervical insufficiency or a previous late loss or very preterm birth, you deserve a careful, evidence-based discussion. I will explain whether laparoscopic transabdominal cerclage fits your story — and what other options exist.

Book an appointment

FAQs

How is laparoscopic transabdominal cerclage different from a vaginal cerclage?
A transvaginal cerclage (e.g. McDonald or Shirodkar) is placed through the vagina around the cervix. Laparoscopic transabdominal cerclage is performed through small abdominal incisions and places the stitch higher on the cervix, at the level where the cervix meets the uterus. It is usually considered when a vaginal approach is not possible or has not worked in a previous pregnancy.
Will I need a caesarean section if I have a transabdominal cerclage?
Yes. Because the stitch is placed abdominally, delivery is almost always by planned caesarean section before labour starts. This is discussed in detail when planning your care.
When in my pregnancy is the cerclage placed?
Laparoscopic transabdominal cerclage is often performed before pregnancy (pre-pregnancy or interval placement) or in early pregnancy, depending on your history and circumstances. Timing is individualised after a full assessment.
What is recovery like after laparoscopic cerclage?
As a keyhole procedure, recovery is usually quicker than open surgery. Many people return to light activities within 1–2 weeks, with a full return to normal exercise over several weeks. You will receive specific advice based on your operation and any other procedures performed.

Please note: This information is general in nature and not a substitute for medical advice tailored to your specific situation.