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Guidelines on cerclage placement: a comparative systematic review.

Aya Mudrik1, Romi Levy2, Alessandro Petrecca3

  • 1Ben-Gurion University of the Negev, Be'er Sheva, Israel (Mudrik).

American Journal of Obstetrics & Gynecology MFM
|June 20, 2025
PubMed
Summary

Professional society guidelines for cervical and abdominal cerclage show agreement on key indications but significant divergence on others, impacting clinical practice. Further harmonization is needed for consistent patient care.

Keywords:
cervical cerclagecervical insufficiencypractice guidelinespreterm birth preventionsystematic review

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Area of Science:

  • Maternal-Fetal Medicine
  • Obstetrics
  • Gynecologic Surgery

Background:

  • Variability in professional society guidelines for cervical and abdominal cerclage contributes to inconsistent clinical practice and patient outcomes.
  • Lack of guideline congruence may affect the standardization of cerclage procedures.

Purpose of the Study:

  • To systematically identify, summarize, and compare professional medical society guidelines for cervical and abdominal cerclage.
  • To highlight areas of consensus and divergence in cerclage recommendations.

Main Methods:

  • Systematic review and narrative synthesis of professional society guidelines.
  • Quality assessment using the AGREE II instrument.
  • Comparative analysis of recommendations on indications, contraindications, timing, technique, and perioperative management.

Main Results:

  • Twenty guidelines from ten professional societies were included, with consensus on history-indicated cerclage (≥3 losses), ultrasound-indicated cerclage (<10 mm cervix), and abdominal cerclage for prior failure or insufficient cervix.
  • Disagreements exist regarding cerclage indications after one loss (ACOG vs. others), timing of physical examination cerclage (24 vs. 28 weeks), and management of prolapsed membranes.

Conclusions:

  • While key indications for cerclage are generally agreed upon, significant variations persist across guidelines.
  • The identified divergences underscore the need for greater consistency in professional society recommendations to improve clinical practice and patient outcomes in cerclage procedures.