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Updated: Jun 22, 2026

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse
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Published on: September 13, 2022

Cervical insufficiency: re-evaluating the prophylactic cervical cerclage.

Haim A Abenhaim1, Togas Tulandi

  • 1Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. haim.abenhaim@gmail.com

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
|May 30, 2009
PubMed
Summary

Cervical cerclage placement is evolving beyond historical obstetrical history. Combining history with ultrasound and biochemical markers improves identification of women who benefit most from cerclage or alternative treatments like progesterone.

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Area of Science:

  • Maternal-Fetal Medicine
  • Obstetrics
  • Gynecology

Background:

  • Cervical cerclage placement traditionally relied on obstetrical history.
  • Recent advancements suggest integrating ultrasonographic and biochemical findings enhances patient selection.

Purpose of the Study:

  • To review current literature on cervical cerclage indications and management strategies.
  • To explore the efficacy of combining historical data with objective measures for improved outcomes.

Main Methods:

  • Literature review of studies on cervical insufficiency and cerclage placement.
  • Categorization of patients into high-risk and low-risk groups based on obstetrical history.
  • Evaluation of adjunctive therapies such as progesterone and serial cervical length measurements.

Main Results:

  • Women with a history of three or more second-trimester losses may benefit from prophylactic cerclage.
  • Progesterone and serial cervical length measurements may be suitable for women without this history.
  • Early cervical shortening can be identified for potential emergency cerclage, possibly enhanced by intra-amniotic inflammation markers.

Conclusions:

  • A multi-faceted approach combining obstetrical history, ultrasound, and biochemical markers optimizes cervical cerclage selection.
  • Abdominal cerclage, potentially placed laparoscopically, may offer a less invasive alternative to McDonald cerclage, warranting further investigation.