From the Research
The preferred method between Shirodkar and laparoscopic cerclage is transvaginal cerclage, including the Shirodkar technique, as it is generally considered first-line for most patients requiring cervical cerclage. This procedure is less invasive, has a shorter recovery time, and has been used successfully for decades with success rates of 80-90% for preventing preterm birth, as seen in a study published in 2021 1. Laparoscopic transabdominal cerclage is usually reserved for patients who have failed a previous transvaginal cerclage or have anatomical abnormalities that make the vaginal approach difficult.
Key Considerations
- Transvaginal cerclage is typically performed between 12-16 weeks of pregnancy under regional anesthesia, using a strong suture material placed high at the level of the internal os.
- The decision between these techniques should be individualized based on the patient's history, cervical anatomy, surgical risk factors, and availability of surgical expertise.
- Patients should be monitored with regular ultrasounds following either procedure to assess cervical length and integrity of the cerclage.
- A study published in 2013 provides guidelines for cerclage placement, including the recommendation to offer elective cerclage at 12 to 14 weeks of gestation for women with a history of three or more second-trimester pregnancy losses or extreme premature deliveries 2.
- Another study published in 2016 reviews the techniques, modifications, risks, efficacy, and evidence-based applications of the cerclage procedure in contemporary clinical practice, emphasizing the need for prospective data evaluating cerclage techniques and modifications 3.
Recommendations
- Transvaginal cerclage, including the Shirodkar technique, is recommended as the first-line treatment for most patients requiring cervical cerclage.
- Laparoscopic transabdominal cerclage may be considered for patients who have failed a previous transvaginal cerclage or have anatomical abnormalities that make the vaginal approach difficult.
- Patients should be closely monitored after cerclage placement to assess the effectiveness of the procedure and to identify any potential complications.
- The most recent and highest quality study, published in 2021, supports the use of transvaginal cerclage, including the Shirodkar technique, as the preferred method for preventing preterm labor 1.