Cervical cerclage (Green-top Guideline No. 75)


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the Royal College of Obstetricians, Gynaecologists

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Key recommendations

  • Women with singleton pregnancies and three or more previous preterm births should be offered a history-indicated cervical cerclage. [Grade B]
  • Women with a singleton pregnancy and a history of spontaneous second trimester loss or preterm birth who have not undergone a history-indicated cerclage may be offered serial sonographic surveillance, as those who experience cervical shortening may benefit from ultrasound-indicated cerclage while those whose cervix remains long (greater than 25mm) have a low risk of second-trimester loss/preterm birth. [Grade B]
  • For women with a singleton pregnancy and no other risk factors for preterm birth, insertion of cervical cerclage is not recommended in women who have an incidentally identified short cervix. [Grade B]
  • In women with a previous unsuccessful transvaginal cerclage, insertion of a transabdominal cerclage may be discussed and considered. [Grade A] [Correction added on 10 March 2023, after original publication: In bullet 4 of the Key Recommendations, the evidence level has been changed from Grade D to Grade A.]
  • In women with a singleton pregnancy insertion of a emergency cerclage may delay birth by an average of 34 days, compared with expectant management/bed rest alone in suitable cases. It may also be associated with a two-fold reduction in the chance of birth before 34 weeks of gestation. However, there are only limited data to support an associated improvement in neonatal mortality or morbidity. [Grade B]
  • The choice of transvaginal cerclage technique (high cervical insertion with bladder mobilization or low cervical insertion) should be at the discretion of the surgeon [Grade C], but the cerclage should be placed as high as is practically possible. [Grade C]

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