Cervical insufficiency and cervical cerclage

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Cervical insufficiency is a significant cause of mid-trimester pregnancy loss and extreme premature delivery.
• Accurate identification of at-risk women and appropriate intervention are crucial for improving pregnancy outcomes.

Purpose of the Study:

• To establish a framework for identifying women at greatest risk of cervical insufficiency.
• To guide clinicians on the circumstances in which cerclage (surgical procedure to prevent premature birth) may be of potential value.

Main Methods:

• Systematic review of published literature including systematic reviews, RCTs, and observational studies.
• Searches of major databases (PubMed, MEDLINE, CINAHL, Cochrane Library) updated to January 2011.
• Inclusion of grey literature from health technology agencies and professional societies.

Main Results:

• Recommends evaluating all pregnant or planning women for risk factors of cervical insufficiency.
• Suggests elective cerclage for women with a history of three or more second-trimester losses or extreme premature deliveries.
• Supports considering cerclage for singleton pregnancies with a history of preterm birth or cervical insufficiency if cervical length is ≤ 25 mm before 24 weeks.
• Advises against cerclage in multiple gestations, even with a history of preterm birth or short cervix.

Conclusions:

• Clinicians should assess risk factors for cervical insufficiency at initial evaluation.
• Cerclage is recommended in specific high-risk singleton pregnancies based on history and cervical length.
• Serial ultrasound assessment of cervical length is recommended for women at risk but not qualifying for cerclage.