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Updated: Jan 15, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
Optimal surgical technique at cervical cerclage to prevent pregnancy loss, a systematic review
Matthew Vaughan1, Alexandra Emms2, Victoria Hodgetts Morton2
1University of Birmingham Medical School, Edgbaston, Birmingham B15 2TT, UK.
Objective:
Cervical cerclage has been used for decades for prevention of preterm birth; no consensus regarding optimal surgical technique exists. This review assesses if Shirodkar's technique (bladder dissection) is superior to McDonald's (without dissection) with respect to pregnancy loss and maternal-fetal outcomes. A secondary aim is to assess potential benefits of double cerclage.
Methods:
Systematic review was conducted, PROSPERO protocol (CRD42023472563). MEDLINE, Embase, CINAHL and Cochrane Library were searched. 1647 abstracts were screened, 22 studies met inclusion criteria. Bias was assessed using ROBINS-I and ROB2 and meta-analysis conducted using RevMan.
Results:
Odds of pregnancy loss and birth <37 weeks did not differ between dissection and no dissection groups (OR 0.95 [95 %CI 0.60-1.48], I238%), (OR 0.86, [95 %CI 0.63-1.19], I223%). Dissection prolonged pregnancy by 2 weeks (MD 2.29 [95 %CI 1.49-3.10], I244%) and reduced birth <32 weeks, (OR 0.43 [95 %CI 0.19-0.61], I20%). Double cerclage reduced pregnancy loss, (OR 0.52 [95 %CI 0.28-0.98], I229%), and birth <28, <32, <34 weeks, however not at <37 weeks, (OR 0.96, [95 %CI 0.64-1.45] I235%).
Conclusions:
No difference in odds of pregnancy loss was evident between surgical techniques, however dissection was associated with prolongation of pregnancy by 2 weeks and reduced odds of birth <32 weeks. Double cerclage may provide additional benefits in prevention of preterm birth. Overall quality of evidence is low.Choice of technique should be informed by obstetric history, clinical examination, and clinician preference.
