[A modified Shirodkar procedure--double cervical cerclage with an auxiliary loop]

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine

Background:

• Cervical cerclage is a treatment for cervical incompetence, aiming to prevent premature birth.
• Standard cerclage placement high at the internal os is effective, but higher placements can complicate suture removal.
• Existing methods like double cerclage can achieve higher closure but present challenges with suture removal.

Purpose of the Study:

• To introduce and evaluate a novel modified Shirodkar procedure for cervical cerclage.
• To address the challenge of difficult suture removal associated with high-level cervical cerclage.
• To assess the efficacy and safety of the "double cervical cerclage with an auxiliary loop" technique.

Main Methods:

• A modified Shirodkar procedure, termed "double cervical cerclage with an auxiliary loop," was designed.
• The technique was applied to 31 cases of cervical incompetence.
• Suture removal at term was assessed for ease and complications.

Main Results:

• The modified cerclage technique successfully achieved high-level cervical closure in all 31 cases.
• Suture removal at term was consistently easy and uncomplicated.
• No complications were reported in relation to the cerclage or its removal.

Conclusions:

• The "double cervical cerclage with an auxiliary loop" is an effective modification of the Shirodkar procedure.
• This technique facilitates high-level cervical closure while simplifying suture removal.
• The method offers a safe and practical solution for managing cervical incompetence, particularly in cases requiring high cerclage placement.