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This study aimed to identify patient characteristics that affect the success rate of transabdominal cerclage to prevent extreme preterm birth in women with cervical insufficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>Single\u2010center retrospective cohort study in 87 women who underwent transabdominal cerclage by open laparotomy during first and early second trimester of pregnancy over a 20\u2010year period. Participants were divided into subgroups according to indication for the intervention. Linear regression and meta\u2010regression\u2010analyses were performed to assess the effect of mean cervical length (before and after transabdominal cerclage placement) and gestational age of previous preterm birth, on gestational age at delivery. Kaplan\u2013Meier analysis was performed to evaluate treatment effects on gestational age at delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 87 women, 62 women underwent a history\u2010indicated and 25 an ultrasound\u2010indicated transabdominal cerclage. Fetal survival was 92%: 91% in the history\u2010indicated and 96% in the ultrasound\u2010indicated group. Median gestational age at delivery was 37.3\u2009weeks, with a median pregnancy prolongation of 163.0\u2009days and with 92% of deliveries \u226534\u2009weeks. Between groups, irrespective of singleton and twin pregnancies, outcomes were comparable. Gestational age at delivery was neither affected by cervical length before transabdominal cerclage, distance between transabdominal cerclage and external os, gestational age of previous preterm birth nor additional progesterone treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The efficacy of transvaginal cerclage placement via open laparotomy during high\u2010risk pregnancy is favorable and relates to fetal survival of 92%. Regardless of indication, pregnancy outcomes after transabdominal cerclage are similar, and independent of gestational age at previous preterm birth, cervical length before transabdominal cerclage placement, distance between transabdominal cerclage and external os, and additional progesterone administration.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15065","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T11:39:19Z","timestamp":1738928359000},"page":"685-696","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy of transabdominal cerclage by open laparotomy relative to existing risk factors"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4064-3855","authenticated-orcid":false,"given":"Cecile C.","family":"Hulshoff","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc E. 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