FIGO good practice recommendations on cervical cerclage for prevention of preterm birth
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Cervical cerclage
Cervical insufficiency
Second trimester
Premature birth
The diagnosis of cervical incompetence remains extremely difficult because there is no diagnostic test available prior to, during or after pregnancy. This review will summarize the latest publications on the use of transvaginal ultrasonography to identify women at high risk of preterm delivery and the use of cervical cerclage in these women.Cervical length is not only inversely related to the risk of preterm delivery but also inversely related to the risk of intrauterine infection in women with preterm labor. Furthermore, previous history of preterm delivery is related to the risk of preterm delivery. Cerclage trials on women with short cervical length present conflicting results both in low and high-risk populations. Assessment of risk factors and obstetric history remain important in the diagnosis of cervical incompetence. Women at high risk of preterm delivery due to cervical incompetence should be followed-up with transvaginal measurements of cervical length. Only a minority of these women will develop a short cervical length and will consequently be at high risk of preterm delivery.A combination of assessment of risk factors, obstetric history and follow-up of cervical length enables us to identify women who benefit from a cervical cerclage.
Cervical cerclage
Cervical insufficiency
Obstetric history
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Cervical cerclage
Cervical insufficiency
Second trimester
Cervical dilatation
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Cervical cerclage has been used in the management of cervical insufficiency for several decades, yet the indications are uncertain and benefits questionable. It remains a controversial intervention. We present a case of cervical incompetence in a 33-year-old Gravida 5 Para 0+4 woman who had an emergency cervical cerclage at 18 weeks gestation and subsequently delivered of a live male infant at 29 weeks gestation following preterm premature rupture of fetal membrane.
Cervical cerclage
Cervical insufficiency
Cervical dilatation
Second trimester
Expectant management
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Objective:To compare the clinical therapeutic effects of cervical cerclage and bed rest to prevent preterm delivery on pregnants with cervical insufficiency.Methods:Applying retrospective study,we collected the medical history information on 83 women diagnosised as cervical insufficiency from 2005 to 2007 in the department of gynaecology and obstetrics of our hospital.In 83 women,55 women assigned to receive cervical cerclage(A group),28 women assigned to receive bed rest(B group).Results:Preterm delievery before 34 weeks of gestation occurred in 7 of 55 women (90.90%) treated with cervical cerclage,and in 4 of 28 women (21.43%) treated with bed rest.There was significant difference in gestation age at delivery between the 2 groups.Conclusion:Cervical cerclage is an effective approach to treat cervical insufficiency and prevent preterm delivery.
Cervical insufficiency
Cervical cerclage
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Many second trimester miscarriages and neonatal deaths are caused by cervical incompetence.In second trimester if the membranes prolapse in vagina due to cervical incompetence it can be technically very difficult for the clinician to push the membranes back in cervix and apply cerclage to prolong the pregnancy.We present a case of 30 year old primi gravida who came to emergency at 22 weeks of gestation with cervix dilated to 4 cms and membranes prolapsing till the vagina.After ruling out possibility of infection, decision for rescue cerclage was taken.The membranes were deposited back in the uterus with help of Chhattisgarh balloon and Mac Donald's stitch was applied.Patient could successfully carry her pregnancy till 35 weeks and baby did not need NICU admission.Chhattisgarh balloon can be a useful tool in low resource country like India where it can be easily prepared, inexpensive and less traumatic compared to other alternatives available as of now.
Cervical insufficiency
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Cervical cerclage
Cervical insufficiency
Second trimester
Cervical dilatation
Expectant management
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Cervical cerclage is an obstetric procedure performed for prevention of prematurity. Cerclage was first introduced by Drs Shirodkar and McDonald in the mid-1950s for women with repeated second trimester losses and cervical changes in current pregnancy. Currently, cerclage placement is based on 3 common indications in singleton gestations, including history-indicated (prior multiple early preterm births or second trimester losses), ultrasound-indicated (cervical length <25 mm before 24-wk gestational age in women with prior spontaneous preterm birth) and physical examination-indicated (cervical dilation on manual or physical examination before 24 wk).
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Cervical insufficiency
Cervical dilation
Second trimester
Obstetric history
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Cervical dilatation
Second trimester
Cervical insufficiency
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Cervical cerclage
Cervical insufficiency
Second trimester
Cervical dilatation
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