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Laparoscopic Cervical Cerclage Offers Greatest Benefit for Patients With Multiple Conizations or Significantly Shortened Cervix: A Retrospective Study Based on Causal Inference Modeling
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DOI：10.1111/jog.70261.png)
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Abstract
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Aim: To evaluate the comparative effectiveness of laparoscopic cervical cerclage (LACC) versus transvaginal cervical cerclage (TVCC) in improving pregnancy outcomes for patients with a history of cervical conization, and to identify patient subgroups deriving the greatest benefit from LACC using causal inference methodology. Methods: This single-center retrospective cohort study included 179 patients with prior conization who underwent either TVCC (n = 110) or LACC (n = 69). Inverse probability of treatment weighting (IPTW) was employed to control for confounding and simulate a randomized trial scenario. The primary outcome was term delivery rate (>= 37 weeks). Secondary outcomes included gestational age at delivery, neonatal birth weight, and late miscarriage rate. Treatment effect heterogeneity was analyzed via subgroup analysis and restricted cubic splines. Results: After IPTW adjustment, baseline covariates were well-balanced. LACC was associated with a significant absolute increase of 9.4% in the term delivery rate compared to TVCC (81.2% vs. 71.8%; ARD: +9.4%, 95% CI: 1.5 to 17.3; p = 0.020). LACC also demonstrated significant advantages in prolonging gestational age (MD: +0.8 weeks, p = 0.002), increasing neonatal birth weight (MD: +298 g, p = 0.002), and reducing late miscarriage (ARD: -5.6%, p = 0.045). A marked non-linear relationship was identified between pre-cerclage cervical length and LACC benefit, with maximum absolute benefit exceeding 30% when cervical length was < 2.0 cm. Conclusion: LACC is superior to TVCC in improving pregnancy outcomes for patients with a history of cervical conization, particularly for those with multiple prior conizations (>= 2) or significantly shortened cervical length (< 2.0 cm). These findings support the use of LACC as a preferred, precision intervention for this high-benefit population.
Keywords:
cervical insufficiency
laparoscopic cervical cerclage
precision surgery
preterm birth
transvaginal cervical cerclage
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