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Cervical cerclage is performed as an attempt to prolong pregnancy in certain women who are at higher risk of preterm delivery. Cerclage placement may be indicated by a history of cervical insufficiency or by certain sonographic or physical exam findings in a current pregnancy. The McDonald and Shirodkar techniques, or modifications thereof, are the most commonly used methods for placing a cerclage. This activity reviews the indications, contraindications, and techniques for performing a cervical cerclage and highlights the role of the interprofessional team in evaluating, treating, and managing patients who are candidates for this procedure. Objectives: Describe the risk factors for cervical insufficiency. Identify the indications for cervical cerclage placement. Outline the common methods of a cervical cerclage procedure. Collaborate with the interprofessional team to improve patient care. Access free multiple choice questions on this topic.

Throughout the natural course of pregnancy, the cervix remains long, thick and firm until the late third trimester when it slowly begins to soften, dilate and efface to eventually allow the passage of a fetus. The inability of a cervix to maintain its integrity prior to that time can result in miscarriage or preterm birth. When this occurs in the absence of clinical signs or symptoms of labor, it is referred to as cervical insufficiency or incompetence. In the past, nonsurgical approaches such as activity restriction and pelvic rest have been suggested, though their use has not proven effective and should be discouraged.[1] Cervical cerclage is a surgical procedure that can be performed in an attempt to maintain the structural integrity of the cervix in order to prolong gestation and improve obstetrical outcomes.

This procedure is not without risk, but the ultrasound-indicated and physical examination-indicated cerclages likely incur more risk than history-indicated cerclages. Risks include infection or sepsis, inadvertent rupture of membranes, lacerations at the surgical site, and anesthesia-related complications. Recent reviews suggest that initial dilation greater than 4cm is associated with a poor prognosis.[9] These risks must be weighed against the benefit of the structural support of the cervix.

Cervical cerclage is a common obstetric procedure performed in an attempt to improve cervical integrity, prolong gestation, and prevent preterm birth. A cerclage may be indicated by history, ultrasound findings, or physical exam. They should be performed by a skilled obstetrician for the indications described above. Through a combined effort of the patient in obtaining early prenatal care, the radiologist in taking careful cervical length measurements, and the obstetrician in conducting a thorough history and physical exam, it is possible that neonatal morbidity and mortality can be reduced via cerclage placement in select populations.