What is the percentage of cervical insufficiency among the causes of habitual miscarriage? There are many reasons for miscarriage, but a high percentage of miscarriages in early and late pregnancy (around the fifth month of pregnancy) with a viable fetus are due to cervical insufficiency. What is the difference between transvaginal cervical cerclage and laparoscopic cervical cerclage in the treatment of cervical insufficiency? To understand the difference between the two, it is important to first understand the anatomy of the uterus. The cervix is divided into two parts, bounded by the attachment to the vaginal wall. The part of the cervix that protrudes from the vagina is called the vaginal segment, and the opening of the cervix in the vagina is called the external cervical opening. Transvaginal cervical cerclage is usually performed in the early stages of pregnancy (around 14 weeks) by ligating the vaginal segment of the cervix. The location of the ligation corresponds to the middle segment of the cervix, while the internal opening of the cervix remains unclosed. If the internal opening of the cervix opens as the gestational weeks increase, it will still easily cause contractions. Once contractions are induced, miscarriage will inevitably occur, and if the stitches are not removed in time, there is a risk of cervical tearing. In addition, due to the presence of the foreign body of the annuloplasty wire, the surgical wound of transvaginal cervical cerclage is susceptible to infection, and some patients may contract amnionitis, which may lead to premature rupture of the membranes, resulting in miscarriage. The laparoscopic cervical cerclage is positioned at the endocervix, which is equivalent to blocking the dilatation of the cervical canal at its source, thus avoiding causing contractions and thus miscarriage. This is similar to blocking a tube surge on a river bank; if the exit of the tube surge is blocked from outside the bank, it will soon be washed away. Only from the embankment tube surge entrance blocking blocking, can be completely blocked to prevent the river water along the tube surge outflow, resulting in the collapse of the embankment. Therefore, laparoscopic cervical cerclage is more in line with the anatomical structure of the cervix, and after the cerclage, the endocervical opening is closed and no severe contractions will occur, thus avoiding miscarriage. Meanwhile, after transvaginal cervical cerclage, pregnant women need to be strictly bedridden, even to urinate and defecate; however, laparoscopic cervical cerclage does not require bedridden and pregnant women can move freely as in normal pregnancy. Should laparoscopic cervical cerclage be done before or after pregnancy? It can be done before and after pregnancy. After pregnancy, the procedure is usually done at 6-8 weeks of pregnancy, the greater the gestational week, the more difficult the procedure. What are the disadvantages of laparoscopic cervical cerclage? Pregnant women with laparoscopic cervical cerclage can only have a cesarean delivery at full term and not a normal delivery. If fetal loss occurs in the middle of pregnancy, a cesarean section or laparoscopic removal of the stitches is required to allow the fetus to be delivered vaginally. Is laparoscopic cervical cerclage still possible for many patients who have failed transvaginal cerclage? Yes, this is one of the advantages of laparoscopic IUI and there are not many of these patients. There are many patients who have failed vaginal cerclage and then undergo laparoscopic cervical cerclage and have a successful pregnancy and child.