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Background: Detailed pre-operative description of endometriotic lesions by non-invasive methods is an important tool for accurate diagnosis and effective treatment of the disease. Transvaginal ultrasound (TVUS) is a sensitive method for diagnosis of deep infiltrating endometriosis (DIE); however, it is highly operator-dependent and consistent results require adequately trained and experienced clinicians., Aims: The aim of the study is to assess the accuracy of TVUS in predicting DIE by comparing it with laparoscopic findings. We also compared US done in the community by general radiologists with examinations done by specialist gynaecologists., Materials and Methods: A retrospective cohort study of patients who underwent laparoscopy for excision of possible endometriosis between July 2014 to February 2019 who had a TVUS prior to laparoscopy., Results: A total of 119 patients were included. TVUS was shown to be useful in detecting all but bladder DIE. Community TVUS was no better than chance at identifying most DIE (area under the curve (AUC) of 0.48-0.60) except in the detection of ovarian endometriomas and adhesions (AUC = 0.84). Specialist TVUS correctly identified most DIE with greatest utility for DIE in rectosigmoid (AUC = 0.85, P < 0.000), followed by pouch of Douglas/pouch of Douglas adhesions (AUC = 0.82, P < 0.000), ovarian endometriomas/ovarian adhesions (AUC = 0.79, P < 0.000), uterosacral ligaments (AUC = 0.75, P < 0.000) and rectovaginal septum (AUC = 0.69, P < 0.05)., Conclusion: Specialist TVUS is informative in examining the presence of DIE particularly in posterior compartments which may increase surgical complexity. Community TVUS is significantly less beneficial; however, it is more accessible to the general public. This adds to the argument that increasing access to DIE-TVUS appears favourable., (© 2020 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Transabdominal cerclage can reduce the risk of preterm birth in women with cervical insufficiency., Aims: This study evaluated outcomes following insertion of a laparoscopic transabdominal cerclage in pregnant women., Materials and Methods: A retrospective observational study., Patients: pregnant women who underwent laparoscopic transabdominal cerclage from 2011 to 2017. Eligible women had cervical insufficiency and were not suitable for a transvaginal cerclage., Intervention: the insertion of a laparoscopic transabdominal cerclage in the pregnancy., Measurements: neonatal survival, delivery of an infant at ≥34 weeks gestation and surgical morbidity were evaluated., Results: Of 19 women who underwent laparoscopic transabdominal cerclage in pregnancy, at 6-11 weeks gestation, the perinatal survival rate was 100%. There were no complications. The average gestational age at delivery was 37.1 weeks. Sixteen women delivered after 34 weeks., Conclusions: Laparoscopic transabdominal cerclage is a safe and effective procedure in women with poor obstetric histories. It requires the correct skill, expertise and patient selection., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Cervical insufficiency is a significant cause of morbidity and mortality. Cervical cerclage is one option in the management of cervical insufficiency., Aim: To evaluate obstetric outcomes following insertion of a pre-pregnancy laparoscopic transabdominal cerclage in women at high risk for pre-term labour and/or mid-trimester pregnancy loss., Methods: A prospective observational study of consecutive women who underwent laparoscopic transabdominal cerclage from 2007 to 2017. Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix and were considered not suitable for a transvaginal cerclage. The primary outcome was neonatal survival and the secondary outcome was delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated., Results: During the study period, 225 women underwent laparoscopic transabdominal cerclage. We present the outcomes of 121 pregnancies resulting in 125 babies. The perinatal survival rate of viable pregnancies was 98.5% with a mean gestational age at delivery of 35.2 weeks; 79.7% of babies were delivered at ≥34.0 weeks gestation., Conclusion: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. For optimal success the procedure requires the correct surgical expertise, equipment and appropriate patient selection., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Cervical cerclage has been used as a treatment for cervical insufficiency for over 60 years. Transabdominal cerclage is indicated for cervical insufficiency not amenable to a transvaginal procedure, or following previous failed vaginal cerclage. A laparoscopic approach to abdominal cerclage offers the potential to reduce the morbidity associated with laparotomy., Aims: To evaluate the obstetric outcome and surgical morbidity of laparoscopic transabdominal cerclage., Methods: An observational study of consecutive women undergoing laparoscopic transabdominal cerclage from 2007 to 2013 by a single surgeon (AA). Eligible women had a diagnosis of cervical insufficiency based on previous obstetric history and/or a short or absent cervix. The primary outcome was neonatal survival. Secondary outcomes were delivery of an infant at ≥34 weeks gestation. Surgical morbidity and complications were also evaluated., Results: Sixty-four women underwent laparoscopic transabdominal cerclage during the study period. Three women underwent cerclage insertion during pregnancy; the remaining 61 were not pregnant at the time of surgery. Thirty-five pregnancies have been documented to date. Of those, 24 were evaluated for the study. The remaining cases were either early miscarriages, ectopic pregnancies or are still pregnant. The perinatal survival rate was 95.8% with a mean gestational age at delivery of 35.8 weeks. Eighty-three per cent of women delivered at ≥34 weeks gestation. There was one adverse intra-operative event (1.6%), with no postoperative sequelae., Conclusion: Laparoscopic transabdominal cerclage is a safe and effective procedure resulting in favourable obstetric outcomes in women with a poor obstetric history. Success rates compare favourably to the laparotomy approach., (© 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)

Background: Transabdominal cervical cerclage has been performed via laparotomy for over four decades. A laparoscopic approach has recently been developed and offers the potential for lower morbidity., Aims: The experience of one operator with transabdominal cervical cerclage via laparotomy is reviewed to establish a baseline with which to compare results from the laparoscopic approach., Methods: Transabdominal cervical cerclage was performed with Mersilene tape. The pregnancy outcome prior to transabdominal cervical cerclage was compared with the outcomes after its insertion., Results: Prior to transabdominal cervical cerclage, there were 58 pregnancies of which 18 ended with a first trimester pregnancy loss. Twenty-eight of the 36 pregnancies delivering between 13- and 26-week gestation resulted in a pregnancy loss. Three of the four children delivered after 26-week gestation survived. Following transabdominal cervical cerclage, there were no first trimester pregnancy losses. Of the 23 pregnancies after transabdominal cerclage, one was terminated at 18-week gestation for spina bifida and the remaining 22 babies were delivered at a mean gestation of 36.2 weeks. Maternal morbidity was limited to a single wound infection. Respiratory distress was the only significant neonatal morbidity with all babies recovering completely., Conclusions: Transabdominal cervical cerclage via laparotomy is a safe and successful method of treating women who need a cervical cerclage but are unable to have a vaginal suture. A baseline has been established with which to compare the results from laparoscopic transabdominal cervical cerclage in the future., (© 2010 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology © 2010 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)