From the Research
For patients with an abdominal cerclage, the recommended timing of delivery is typically between 36 and 37 weeks of gestation via planned cesarean section. This recommendation is based on the most recent and highest quality study available, which suggests that removal of the cerclage is considered at 36-37 weeks in women anticipating a vaginal delivery, but since an abdominal cerclage requires a cesarean delivery, this timing is also applicable 1. The abdominal cerclage, unlike a transvaginal cerclage, cannot be removed vaginally and requires a cesarean delivery since it is placed at the level of the internal cervical os through an abdominal approach.
Prior to the scheduled delivery, patients should receive antenatal corticosteroids (betamethasone 12 mg intramuscularly, two doses 24 hours apart, or dexamethasone 6 mg intramuscularly, four doses 12 hours apart) if delivery is planned before 39 weeks to promote fetal lung maturity. Patients should be monitored closely in the third trimester for signs of preterm labor, as spontaneous labor with an abdominal cerclage in place can lead to uterine rupture or other complications. If preterm labor occurs before the planned delivery date, immediate cesarean section is typically necessary. The cerclage may be left in place for future pregnancies or removed during the cesarean delivery if no future pregnancies are desired.
Some studies have discussed the use of postoperative vaginal progesterone in patients who underwent ultrasound-indicated cerclage, but this is not directly relevant to the timing of delivery for patients with an abdominal cerclage 2. Other studies have discussed the technique and safety profile of uterine evacuation in patients with transabdominal cerclage, but this is also not directly relevant to the timing of delivery 3. The key consideration for patients with an abdominal cerclage is the balance between the risks of prematurity and the risks of spontaneous labor with the cerclage in place, and the recommended timing of delivery between 36 and 37 weeks of gestation via planned cesarean section is the most appropriate approach based on the available evidence 1.
The use of laparoscopic cerclage has been described in some studies, but the timing of delivery for patients with an abdominal cerclage remains the same regardless of the approach used for cerclage placement 4. The interval to spontaneous delivery after elective removal of cerclage has also been studied, but this is not directly relevant to the timing of delivery for patients with an abdominal cerclage, which requires a cesarean delivery 5. Overall, the recommended timing of delivery for patients with an abdominal cerclage is between 36 and 37 weeks of gestation via planned cesarean section, based on the most recent and highest quality study available 1.