Objective:

To compare the clinical efficacy of laparoscopic cervical cerclage (LAC) and transvaginal cervical cerclage (TVC) in treating cervical insufficiency (CI) patients after hysteroscopic adhesiolysis for intrauterine adhesions (IUA) from January 2018 to January 2024.

Key Findings:

• LAC group had a higher term delivery rate (89.4% vs. 71.2%, P = 0.005).
• LAC group had a higher neonatal survival rate (98.5% vs. 90.4%, P = 0.027).
• LAC group had a lower preterm birth rate before 34 weeks (9.1% vs. 20.2%, P = 0.036).
• LAC group had a lower infection rate (3.0% vs. 10.6%, P = 0.029) and suture slippage rate (1.5% vs. 9.6%, P = 0.015).
• TVC group had a higher cervical laceration rate (5.8% vs. 1.5%, P = 0.048).
• LAC group had a higher cesarean section rate (98.5% vs. 26.9%, P < 0.001).

Interpretation:

LAC is superior to TVC in improving term delivery rates and reducing late miscarriage in CI patients after IUA surgery, particularly for those with moderate-to-severe IUA. Individualized surgical selection based on patient-specific factors is crucial.

Limitations:

• Retrospective design may introduce selection bias.
• Single-center study limits generalizability.

Conclusion:

Individualized surgical selection is recommended based on IUA severity and patient conditions.