Practice Bulletin No. 142: Cerclage for the Management of Cervical Insufficiency

@article{Odibo2014PracticeBN,
  title={Practice Bulletin No. 142: Cerclage for the Management of Cervical Insufficiency},
  author={Anthony O Odibo},
  journal={Obstetrics \& Gynecology},
  year={2014},
  volume={123},
  pages={372–379}
}
  • A. Odibo
  • Published 1 February 2014
  • Medicine
  • Obstetrics & Gynecology
The inability of the uterine cervix to retain a pregnancy in the second trimester is referred to as cervical insufficiency. Controversy exists in the medical literature pertaining to issues of pathophysiology, screening, diagnosis, and management of cervical insufficiency. The purpose of this document is to provide a review of current evidence of cervical insufficiency, including screening of asymptomatic at-risk women, and to offer guidelines on the use of cerclage for management. The… 
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211 Citations
Highly Influential Citations
5
Background Citations
5
Methods Citations
2

211 Citations

Laparoscopic Transabdominal Cerclage: Surgical Technique and Review of Literature

The lack of a universally accepted definition and pathognomonic confirmatory diagnostic test challenges the clinical abilities for a correct diagnosis of cervical incompetence.

Current views on the possibility of cervical insufficiency correction

Methods for the prevention of preterm delivery in multiple pregnancy, such as the introduction of a specialized outpatient service, bed rest, antibacterial therapy, progesterone, preventive cerclage or the insertion of a pessary do not change the incidence and mortality of newborns.

The Effectiveness of Rescue Cervical Cerclage: A Retrospective Observational Study

Emergency or rescue cervical cerclage is fundamentally a salvage procedure to prolong pregnancy in women with advanced cervical dilatation or prolapsed membranes in the second trimester who carried out vaginal bleeding, discharge, or pelvic pressure sensation and the results were evaluated.

Laparoscopic Cerclage in Pregnant and Nonpregnant Uterus: Emerging Need to change Conventional Management Approach

Comparing both approaches (conventional and laparoscopy) in the management of cervical incompetence/ insufficiency both in pregnant and nonpregnant uterus is discussed.

The outcome of pregnancy following the cerclage

  • Medicine
  • 2020
According to this study, the failure of the cerclage is associated with previous history of dilation and curettage (D&C) and higher gravidity, and the prognosis is considered good, in case the termination is above 32 weeks.

Emergency Cervical Cerclage

This review confirms that emergency cerclage reduces the rate of preterm birth in patients with advanced cervical insufficiency and prolongs gestational age and improves the chances of survival of the newborn without increasing the risk of chorioamnionitis and preterm premature rupture of membranes.

Cervical Cerclage: A Review and Rethinking of Current Practice

Systematic review evidence offers TAC as a more effective procedure to TVC in reducing preterm birth and maximizing neonatal survival and advances in minimally invasive surgery now allow gynecologists to perform this moreeffective procedure laparoscopically without the added morbidity of open surgery but with the same if not better outcomes.

Transabdominal cerclage for cervical insufficiency in twins: series of seven cases and literature review

  • F. DebièveAude JoskinP. SteenhautP. BernardC. Hubinont
  • Medicine
    The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
  • 2019
Perinatal outcomes are considerably improved in twin pregnancies with transabdominal cerclage and this findings corroborate those of previous case reports and support the efficacy of TAC for managing cervical insufficiency in twin pregnancy.

Cerclage Use: A Review of 3 National Guidelines.

A cohesive international guideline may improve safety and quality and optimize patient outcomes and outline variations in indications and contraindications for cervical cerclage use by international guideline.

Effectiveness of emergency cerclage in cervical insufficiency

Emergency cerclage is a valid therapeutic option between the 14th and 24th gestational week in presence of cervical insufficiency when signs of premature labour or infection are not present, with lower expectations with a dilatation greater than 5 cm.
...

References

SHOWING 1-10 OF 46 REFERENCES

Habitual abortion: a radiographic technique to demonstrate the incompetent internal os of the cervix.

Alternative treatment for a short cervix: the cervical pessary.

The pessary may represent an easy and safe intervention in the treatment of a short cervix diagnosed in the midtrimester, and further research is merited to evaluate the role of the cervical pessaries as an alternative treatment for a long cervix or for women at high risk for preterm birth.

Emergent cervical cerclage: predictors of success or failure.

A retrospective review of maternal characteristics predictive of perinatal survival showed the presence of membrane prolapse to be the strongest predictor of poor outcome and a significant association between initial white blood cell count andperinatal outcome.

Cervical resistance in patients with previous spontaneous mid‐trimester abortion

This new procedure which is used in the non‐pregnant state provides an additional method for diagnosis of cervical incompetence.

Cervical cerclage in the second trimester of pregnancy: a historical cohort study.

Cervical cerclage was associated with an improved perinatal outcome (in comparison with conservative therapy) in women with early cervical changes detected by ultrasonography and in patients with advanced cervical dilatation and visible membranes.

Cervical cerclage and preterm PROM.

Retention of cerclage for more than 24 hours after PPROM was found to prolong pregnancy for morethan 48 hours, but also to increase maternal chorioamnionitis and neonatal mortality from sepsis, making immediate ceramic removal as the usually preferred therapeutic approach.

Outcome of second-trimester, emergency cervical cerclage in patients with no history of cervical incompetence.

It is concluded that emergency midtrimester cervical cerclage among patients with no prior evidence of cervical incompetence is associated with an approximately 50% survival rate, and Membranes protruding through the dilated cervix are a poor prognostic factor for survival in these cases.

Does cervical cerclage prevent preterm delivery in patients with a short cervix?

Cervical cerclage in patients with a short cervix did not reduce the rate of spontaneous preterm delivery and increased the risk of preterm premature rupture of membranes.

A randomized controlled trial of cervical cerclage in women at high risk of spontaneous preterm delivery

The patients in the cerclage group were more likely to receive tocolytic drugs, and more of them experienced puerperal pyrexia, although these differences between the groups were not statistically significant.

Transabdominal cervical cerclage during pregnancy. A modified technique.

  • M. Mahran
  • Medicine
    Obstetrics and gynecology
  • 1978
A modified surgical technique for carrying out cervical cerclage by the transabdominal route during pregnancy is presented. It is designed for the patient whose cervix is so short or damaged that the…