Emergency Cerclage: Outcomes, Patient Selection, and Operative Considerations

Emergency cerclage refers to a cerclage placed during the second trimester in a woman noted to have painless cervical dilation. Although randomized-controlled trials are limited, observational studies suggest an improvement in neonatal outcomes in selected patients undergoing an emergency cerclage. Labor and chorioamniontis are contraindications for cerclage placement. Advanced dilation (>3 to 4 cm) and a later gestational age (22 to 24 wk) are associated with poorer outcomes. This chapter reviews the indications, outcomes and perioperative management strategies for cerclage placement in this setting.