Related Experiment Video
Updated: Jun 28, 2026
03:43
Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse
Published on: September 13, 2022
Against Recommending History Indicated Cerclage.
Ilaria Paladino1,2, Vincenzo Berghella1
1Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA.
Clinical Obstetrics and Gynecology
|June 26, 2026
Summary
Cerclage, a procedure to prevent preterm birth, is effective when indicated by ultrasound. History-indicated cerclage is reserved for specific high-risk cases based on prior pregnancy outcomes.
Area of Science:
- Maternal-Fetal Medicine
- Obstetric Ultrasound
- Surgical Obstetrics
Background:
- Cerclage, developed by Shirodkar and McDonald, addresses second-trimester cervical changes.
- Randomized controlled trial (RCT) data validate ultrasound-indicated cerclage (UIC).
- Despite 70 years of research, evidence-based indications for history-indicated cerclage (HIC) remain limited.
Purpose of the Study:
- To review the evidence-based indications for cerclage.
- To outline current screening and management protocols for cerclage.
- To emphasize the role of transvaginal ultrasound cervical length (TVU CL) in cerclage decision-making.
Main Methods:
- Review of randomized controlled trials (RCTs) and clinical guidelines.
- Analysis of indications for history-indicated cerclage (HIC) and ultrasound-indicated cerclage (UIC).
- Description of transvaginal ultrasound cervical length (TVU CL) screening protocols.
Main Results:
- History-indicated cerclage (HIC) is indicated for ≥3 spontaneous preterm births (SPTBs) or early second-trimester losses.
- Ultrasound-indicated cerclage (UIC) is recommended for preterm birth <32 weeks.
- Transvaginal ultrasound cervical length (TVU CL) screening is crucial for identifying candidates for UIC.
Conclusions:
- Transvaginal ultrasound cervical length (TVU CL) screening should be standard for all patients.
- Ultrasound-indicated cerclage (UIC) thresholds vary based on singleton/twin status and prior SPTB history.
- Cerclage decisions should be guided by robust evidence and objective ultrasound measurements.
