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Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy
Zarko Alfirevic1, Tamara Stampalija, Devender Roberts
1Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK. zarko@liverpool.ac.uk.
The Cochrane Database of Systematic Reviews
|April 20, 2012
Summary
Cervical cerclage (stitch) reduces preterm birth in high-risk pregnancies but does not significantly lower perinatal deaths or neonatal morbidity. This procedure increases the likelihood of Cesarean sections and potential maternal side effects, necessitating personalized care decisions.
Area of Science:
- Obstetrics and Gynecology
- Maternal-Fetal Medicine
- Surgical Interventions in Pregnancy
Background:
- Cervical cerclage involves placing a suture around the cervix during pregnancy to provide mechanical support and reduce preterm birth risk.
- The efficacy and safety of cervical cerclage remain subjects of ongoing debate and research.
- High-risk pregnancies, defined by a history of pregnancy loss or ultrasound findings of a short cervix, are the primary candidates for this procedure.
Purpose of the Study:
- To evaluate the effectiveness of cervical cerclage in singleton pregnancies at high risk of pregnancy loss.
- To determine if cervical cerclage improves obstetric care and fetal outcomes in at-risk pregnancies.
- To assess the impact of cervical cerclage compared to no treatment or alternative interventions.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched the Cochrane Pregnancy and Childbirth Group's Trials Register and reference lists.
- Included 12 RCTs involving 3328 women comparing cerclage with no treatment or alternative interventions.
Main Results:
- Cervical cerclage significantly reduced preterm births (RR 0.80) but showed no statistically significant difference in perinatal deaths (RR 0.78) or neonatal morbidity (RR 0.95).
- The procedure was associated with a higher rate of maternal side effects (e.g., discharge, bleeding, pyrexia) and significantly increased Cesarean section rates (RR 1.19).
- No significant differences were observed in outcomes across subgroups (history-indicated vs. ultrasound-indicated cerclage) or when compared to progesterone treatment.
Conclusions:
- Cervical cerclage effectively reduces preterm birth incidence in high-risk women but without a significant decrease in perinatal mortality or neonatal morbidity.
- The procedure is linked to increased Cesarean section rates and potential maternal complications, with uncertain long-term effects on the infant.
- Personalized decision-making, considering clinical context, team expertise, and patient preference, is crucial for managing recurrent preterm birth risk.
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