Robotic-Assisted Transabdominal Cerclage in a Triplet Pregnancy: Case Report and Literature Review

Abstract

Background: Cervical insufficiency is one cause of preterm birth and its associated neonatal outcomes. Transabdominal cerclage is an option for women with cervical insufficiency and a history of prior failed transvaginal cerclage or anatomical limitations to transvaginal cerclage. Case series and systematic reviews are increasing in the literature showing obstetrical and surgical benefits of laparoscopic and robotic approaches, compared to the conventional laparotomy approach. However, publications on this surgical intervention for women with cervical insufficiency and a pregnancy complicated by multifetal gestation are limited. Case: A 33-year-old, gravida 6, para 0140 African-American woman with history of recurrent cervical insufficiency, including 3 second-trimester deliveries and a prior failed transvaginal cerclage, underwent a robotic-assisted transabdominal cerclage in a trichorionic-triamniotic triplet pregnancy. Results: The patient had an uncomplicated postoperative course and her pregnancy resulted in a 35-week cesarean delivery of 3 healthy newborns. Conclusions: Prophylactic robotic-assisted transabdominal cerclage by an experienced surgeon is a feasible alternative for patients with cervical insufficiency in higher-order multifetal gestation pregnancies.