From the Guidelines
Cervical cerclage is a surgical procedure used to prevent premature birth in women with cervical insufficiency, and its purpose is to support the pregnancy until term by keeping the cervix closed. The procedure involves placing a strong stitch around the cervix, and it is typically recommended for women with a history of second-trimester pregnancy loss due to painless cervical dilation, those with a short cervix (less than 25mm) detected on ultrasound before 24 weeks, or those with physical examination findings of cervical dilation before viability 1. The following are key points to consider:
- Cerclage is usually performed between 12-24 weeks of pregnancy, with the McDonald technique being most common 1.
- Prior to the procedure, patients may receive antibiotics and sometimes tocolytics to prevent contractions 1.
- After cerclage placement, patients typically require 1-2 days of reduced activity, with some physicians recommending pelvic rest for the remainder of pregnancy 1.
- The stitch is usually removed around 36-37 weeks of pregnancy or when labor begins 1.
- Potential complications include rupture of membranes, infection, preterm labor, and suture displacement, making proper patient selection crucial for successful outcomes 1. However, in individuals without a history of preterm birth who have a sonographic short cervix (10-25 mm), cerclage placement is not generally recommended in the absence of cervical dilation 1. It is essential to consider the latest guidelines and evidence-based recommendations when making decisions about cervical cerclage, as the management of short cervix in individuals without a history of spontaneous preterm birth is a complex issue that requires careful evaluation and consideration of individual patient factors 1.
From the Research
Purpose of Cervical Cerclage
The purpose of a cervical cerclage, also known as a cervical stitch, is to provide mechanical support to the cervical canal and keep the cervix closed during pregnancy. This procedure is performed to prevent preterm birth in women with a history of cervical insufficiency or those at high risk of preterm labor [ 2 , 3 ].
Indications for Cervical Cerclage
Cervical cerclage is typically indicated in the following situations:
- History of 3 or more spontaneous preterm births or second trimester losses [ 2 ]
- High-risk patient with a singleton pregnancy who has a short cervix in the second trimester [ 2 ]
- Ultrasound-indicated (cervical length <25 mm before 24-wk gestational age in women with prior spontaneous preterm birth) [ 3 ]
- Physical examination-indicated (cervical dilation on manual or physical examination before 24 wk) [ 3 ]
Benefits of Cervical Cerclage
The benefits of cervical cerclage include:
- Reduction of preterm birth in women with cervical insufficiency [ 4 ]
- Maximization of neonatal survival in women with cervical insufficiency [ 4 ]
- Retention of the mucous plug, which serves as a mechanical barrier between the vagina and the uterine cavity and contains immune components that protect the fetal compartment from ascendent infections [ 5 ]
Comparison with Other Treatments
Cervical cerclage has been compared to other treatments for preventing preterm birth, including vaginal progesterone and cervical pessary. Studies have shown that these treatments have similar effectiveness in women with singleton pregnancy, previous spontaneous preterm birth, and short cervix [ 6 ]. However, direct randomized comparisons of these strategies are needed to determine optimal management.