Julie Glavind

Introduction: A transabdominal cerclage is inserted to prevent recurrent midtrimester loss and spontaneous preterm birth. The transabdominal cerclage often remains as a permanent foreign body for years. Synthetic materials within the abdomen, cesarean birth, and prior adverse pregnancy outcomes have each been associated with long‐term complications or poorer health‐related quality‐of‐life. However, the long‐term effects of a permanent transabdominal cerclage have not been investigated. We aimed to evaluate patient‐reported late effects and health‐related quality‐of‐life in Danish women who underwent transabdominal cerclage between 2004 and 2025. Material and Methods: In this nationwide cohort study, women with a transabdominal cerclage were matched in a 1:1:1 ratio to two comparison groups: (1)women without transabdominal cerclage who had a cesarean birth, and (2)women without transabdominal cerclage who had a non‐instrumental vaginal birth and no prior cesarean birth. Participants completed validated questionnaires assessing quality‐of‐life, anxiety and depression, bladder discomfort, pelvic pain and sexual health. The primary outcome was the General Health scale in SF‐36. Domain‐ and total scale scores were compared between the groups using multiple linear regression. The study was pre‐registered on clinicaltrials.gov (NCT06875401). Results: Two hundred three women with a transabdominal cerclage, 90 with a cesarean section, and 98 with a vaginal birth participated. The mean General Health score did not differ between groups by a predefined minimally important difference of 10 points. Adjusted mean differences were − 4.0 points (95% CI ‐9.5–1.4) for women with cesarean birth and −0.6 (95% ‐CI‐6.2–4.9) for women with vaginal birth in comparison to the transabdominal cerclage group. Mental health, bladder discomfort, pelvic pain, and sexual health symptom burdens were similar between groups. Response rates were higher in the transabdominal cerclage group, which may have introduced selection bias. Cerclage‐related complications leading to suture removal after completed pregnancies were rare (3/203 women, 1.5%). Quality‐of‐life scores tended to be higher with longer time since cerclage procedure. Conclusions: Permanent transabominal cerclage was not associated with poorer self‐reported general health compared with women without transabominal cerclage, regardless of mode of birth. These findings support that a permanent transabominal cerclage does not appear to have long‐term negative health effects.

Introduction: Transabdominal cerclage (TAC) is used to prevent pregnancy loss and preterm birth in women with previous failed transvaginal cerclage or insufficient cervical tissue. TAC requires laparoscopic or open abdominal surgery, cesarean birth, and the potential long‐term effect are currently unknown. While the procedural aspects, indications, and pregnancy outcomes associated with TAC are subject to ongoing research, little is known about how women experience the decision to undergo a TAC and the pregnancy that follows. Material and Methods: We conducted a qualitative interview study with 12 Danish women who had undergone laparoscopic TAC. Participants were recruited through a national online support group. Interviews lasted 58–90 min. Data were analyzed thematically using Braun and Clarke's approach. Results: Two overarching themes were identified. The first theme, What it takes , describes how the decision to undergo TAC was often considered self‐evident and necessary in light of previous pregnancy losses. Thus, the decision‐making was shaped by prior trauma and urgent hope, but also grounded in careful assessment of risks, benefits, and prior experiences. The women downplayed the potential drawbacks of TAC (cesarean birth, long‐term complications) in favor of the chance to carry a healthy baby to term. The second theme, Feeling safe(−r) , describes how the TAC offered reassurance and allowed the woman to be more active during pregnancy compared to previous pregnancy experiences. However, anxiety and emotional vulnerability persisted, rooted in prior losses. Trusting relationships with healthcare providers were described as essential to navigate worry and uncertainty during pregnancy. All women with a TAC pregnancy achieved a live birth. Conclusions: For the women who underwent TAC, the intervention represented hope, and the downsides were perceived to be outweighed by an increased probability of having a healthy baby. The findings highlight the importance of continuity in care and patient‐centered counseling that addresses the clinical and emotional dimensions of TAC. Future research should explore long‐term physical and psychological outcomes and develop supportive interventions to improve care for this high‐risk population.

Introduction: Laparoscopic cervical cerclage is an intervention for the prevention of preterm birth, for example, in women with a weak cervix due to prior cervical surgery or prior failed vaginal cerclage. Little is known about pregnancy outcomes when a cerclage is left in situ across consecutive pregnancies; this study aims to investigate neonatal outcomes following laparoscopic cervical cerclage placement in first and subsequent pregnancies and to compare pre‐ and postconception placement of the laparoscopic cervical cerclage on neonatal survival. Material and Methods: We performed an observational study in women who had a laparoscopic cervical cerclage at Aarhus University Hospital, Denmark, between 2011 and 2021. Data on the timing of the procedure (pre‐ vs post‐conception), surgical complications, obstetric, and neonatal outcomes were collected from electronic patient records and analyzed descriptively. The primary outcome was neonatal survival. Secondary outcomes were neonatal survival without major morbidity, preterm birth, and gestational age at birth. Results: A total of 170 women had a laparoscopic cervical cerclage during the study period. Uterine wall perforation occurred in 10/170 procedures (6%), postoperative infection in 4/170 (2%), and 125/170 (74%) were discharged on the same day as the procedure. There were 145 women with at least one subsequent pregnancy and 229 registered pregnancies in total. In the 185 pregnancies that progressed beyond 20 weeks, 166/181 (92%) delivered ≥34 weeks of gestation. Neonatal survival was 183/186 (98%), and survival without major morbidity was 181/186 (97%). Neonatal outcomes were similar between women with a cerclage placed pre‐ or postconception. Fifty of 145 women (34%) with a cerclage left in situ had more than one pregnancy beyond 20 weeks of gestation. These repeated pregnancies showed consistently favorable outcomes, with neonatal survival rates of 100% in second pregnancies (44/44) and 100% in third pregnancies (4/4). Conclusions: Laparoscopic cervical cerclage supports favorable neonatal outcomes in first and subsequent pregnancies. Neonatal outcomes did not appear to differ based on whether the cerclage was placed pre‐ or postconception. Pregnancies in which the cerclage was left in situ demonstrated high neonatal survival rates and favorable obstetric outcomes in both second and third pregnancies.

Induction of labor is a common obstetric intervention with rates up to 25% in developed countries. However, no accepted definition of failed induction of l

Introduction: Induction of labor (IOL) is a common intervention in industrialized countries. Failed induction is frequently reported, yet there is no consensus on its definition. Since the primary goal of IOL is to initiate labor, progress to the active phase is a more relevant measure of success than the surrogate of caesarean birth. Previous studies on the influence of body mass index (BMI) on the risk of failed IOL are limited. Most rely on data from the United States and define failed IOL primarily by caesarean delivery. This study aims to explore the association between maternal BMI and failed IOL, defined as failure to progress to the active phase of labor. Material and Methods: We studied 22 114 term, singleton women undergoing IOL in the Central Denmark Region from 2013 to 2022. Women with spontaneous prelabor rupture of membranes, uterine scar, or fetal demise were excluded. The main outcome measure was failed IOL, defined as not reaching cervical dilation of 6 cm or more. BMI, our exposure, was modeled as a continuous variable using restricted cubic splines and as a categorical variable stratified according to the World Health Organization BMI groups. Adjusted logistic regression was used in both models to assess the association between BMI and failed IOL. Results: Proportions of nulliparous women with failed IOL ranged between 4% for normal weight and 10% for obesity class III. Adjusted odds ratios for nulliparous women for failed IOL were 1.5 (95% confidence intervals [CI] 1.3, 1.7) for overweight, 1.8 (95% CI 1.4, 2.3) for obesity class I, 2.7 (95% CI 2.2, 3.3) for obesity class II, and 2.9 (95% CI 1.4, 6.0) for obesity class III compared to women with normal weight. In parous women, there was a similar but less pronounced association between BMI and failed IOL with a <2% absolute risk of failed IOL. A similar pattern was found when BMI and failed IOL were modeled using restricted cubic splines. Conclusions: In singleton women with induced labor at term, increasing BMI was associated with higher odds of failed IOL; this association was more pronounced in nulliparous women.

Introduction Transvaginal and transabdominal cerclage procedures have become established interventions to prevent mid-trimester pregnancy loss and preterm birth. Transabdominal cerclage seems to be superior to transvaginal cerclage in women with a history of a failed transvaginal cerclage. However, with the availability of a less invasive laparoscopic procedure, there is limited evidence concerning which type of cerclage to recommend to many other risk groups. The objective of this trial is to compare laparoscopic abdominal cerclage and transvaginal cerclage in women at moderate to high risk of spontaneous preterm birth. Methods and analysis The trial is an open, multicentre, superiority, parallel arm randomised controlled investigator-initiated trial with an embedded internal pilot. Women in whom the clinician has clinical equipoise between laparoscopic and transvaginal cerclage are randomised to either laparoscopic abdominal or transvaginal cerclage in a ratio of 1:1. The trial extends from sites in Denmark, Finland and Norway. The primary outcome is birth Ethics and dissemination The Central Denmark Region Committee on Biomedical Research Ethics, Denmark, Helsinki University Hospital Ethics committee, Finland and the Regional Committees for Medical and Health Research Ethics, Norway approved the trial. This protocol is published prior to complete data collection and analysis. Important protocol changes will be made publicly available on ClinicalTrials.org, on the trial website and distributed electronically to all active sites. Positive, inconclusive as well as negative results from the trial will be published in peer-reviewed international scientific journals. Trial registration number NCT06122506.

Objective: To investigate the association between caesarean birth in the second stage of labour and the risk of spontaneous preterm birth in a subsequent pregnancy. Design: Nationwide register‐based cohort study. Setting: The Danish Medical Birth Registry and The Danish National Patient Register from 1997 to 2021. Population: Women with at least two consecutive births (index birth and subsequent birth) where the index birth was a term singleton. Methods: Women with spontaneous preterm subsequent birth were compared according to the mode of index birth, including vaginal, prelabour caesarean, first stage caesarean and second‐stage caesarean. Statistical analysis was performed using multiple logistic regression. Main Outcome Measure: Spontaneous birth before 37 + 0 gestational weeks. Results: A total of 376 414 women met the inclusion criteria. Distribution of mode of index birth was vaginal 318 117 (84.5%), prelabour caesarean 15 373 (4.1%), first stage caesarean 37 547 (10.0%) and second‐stage caesarean 5377 (1.4%), respectively. The rate of subsequent preterm birth was 1.7%. Compared to vaginal birth, a second‐stage caesarean was associated with an increased risk of preterm birth in a subsequent pregnancy (adjusted odds ratio [aOR] 1.46, 95% confidence interval [CI] 1.21–1.77). Similarly, compared to first stage caesarean, a second‐stage caesarean was associated with an increased risk of preterm birth in the subsequent pregnancy, with an aOR of 1.41 (95% CI 1.15–1.74). Conclusion: Second‐stage caesarean in a previous term pregnancy is associated with an increased risk of spontaneous preterm birth in a subsequent pregnancy.