Shirodkar procedure following failed cervical cerclage: Guidelines on the management of cervical incompetence

ABSTRACT With the aim of evaluating if Shirodkar cerclage is appropriate for patients at high risk of cervical incompetence, we performed a retrospective analysis of the results obtained with this procedure performed over an 8-year period by a single surgeon in 65 women in whom previous cerclage(s) had proved unsuccessful. The women were divided into three groups according to indication for cerclage as follows: (I) 31 women considered at high risk of cervical incompetence based on their obstetric history or altered cervical conditions, 16 of whom had had two or three cerclages without success, (II) 9 women with prolapse of the amniotic sac who required emergency Wurm-Hefner cerclage, and (III) 25 women with a history of conservative operations on the uterus who underwent a prophylactic Shirodkar cerclage (experimental management). The pregnancy outcome was not known in 7 cases. A full-term pregnancy (≥37 weeks of gestation) was achieved in 44 women, and premature delivery (34–36 weeks) occurred in 7 and v...