Standardized perioperative terminology for emergency cervical cerclage: A framework for feasibility and procedural...

Emergency cervical cerclage (ECC) is performed for advanced cervical dilation with exposed or prolapsed membranes and represents the most technically demanding end of the cerclage spectrum. Existing classification systems categorize cerclage by indication but do not characterize operative cervical state at presentation or separate determinants of technical feasibility from modifiers of procedural complexity. The objective was to develop standardized perioperative terminology for describing operative cervical state in ECC and to propose a feasibility-complexity framework based on bulging extent, membrane reducibility, and cervical rim adequacy.

This conceptual framework development study was informed by contemporary ECC literature and tertiary obstetric surgical practice. Operative descriptors recurrently described in ECC studies were synthesized into a structured model comprising three components: bulging extent (B), reducibility of prolapsed membranes (R), and cervical rim adequacy (C). Reducibility and cervical rim adequacy were defined as primary determinants of technical feasibility, whereas bulging extent was designated as a modifier of procedural complexity once feasibility is established. The framework supports structured perioperative assessment at presentation and immediately before or during the procedure.

Integration of the B-R-C components provides standardized perioperative descriptors and defines three feasibility-based operative categories: low-complexity, high-complexity, and technically non-feasible ECC. The framework explicitly separates technical feasibility from procedural complexity and supports consistent perioperative assessment, inter-operator communication, and comparison across clinical settings and studies.

This state-based framework aligns ECC assessment with the operative cervical state encountered at presentation and around the time of surgery, rather than indication alone. By distinguishing indication-based eligibility, technical feasibility, and procedural complexity, it provides standardized perioperative terminology that may improve interpretation of existing evidence, support structured feasibility assessment, and inform future validation studies in ECC.