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Published on: September 12, 2025
Ultrasound-indicated cerclage: Shirodkar vs. McDonald
Heather Hume1, Andrei Rebarber, Daniel H Saltzman
1Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai School of Medicine, New York University School of Medicine, New York, NY, USA.
Objective:
To compare the efficacy of Shirodkar to McDonald cerclage in patients with singleton pregnancies undergoing an ultrasound-indicated cerclage.
Methods:
Historical cohort of all patients with singleton pregnancies undergoing cerclage for the indication of a short cervix on ultrasound (ultrasound indicated) at one institution in 2005-2010. We compared outcomes based on cerclage type, Shirodkar or McDonald. Outcome measures were gestational age (GA) at delivery, delivery ≥35 weeks, ≥32 weeks, and PPROM. Multivariable regression analysis was performed to control for significant variables.
Results:
Seventy-four patients with singleton pregnancies underwent an ultrasound-indicated cerclage in the study period (47 Shirodkar, 27 McDonald). Shirodkar was associated with later GA at delivery (mean GA at delivery 36.98 +/- 3.39 vs. 33.34 +/- 6.37 weeks, p = 0.006), a higher likelihood of delivering ≥35 weeks (83 vs. 55.6%, p = 0.011) and ≥32 weeks (91.5 vs. 59.3%, p = 0.001), and a lower likelihood of preterm premature rupture of membrane (PPROM) (13.0 vs. 46.2%, p = 0.002). On adjusted analysis controlling for differing baseline characteristics, Shirodkar remained significantly associated with an increased incidence of delivery ≥32 weeks (odds ratio [OR]: 5.180, 95% CI: 1.024-26.205).
Conclusion:
Compared to the McDonald technique, the Shirodkar technique was more effective in prolonging pregnancy in patients with singleton pregnancies undergoing ultrasound-indicated cerclage. A prospective trial is needed to compare these two techniques.
