Cervical Cerclage: A Review and Rethinking of Current Practice

Abstract

Importance: Cervical insufficiency (CI) is a serious complication of pregnancy, which can cause preterm birth. Identifying how to most effectively treat CI has the potential to maximize neonatal survival in this population of women.

Objective: To determine whether transabdominal cervical cerclage should be offered as a first-line treatment option in high-risk women.

Evidence acquisition: An electronic literature search for relevant studies was conducted using keywords (CI, cervical cerclage) on the MEDLINE database.

Results: Although transabdominal cerclage (TAC) is reserved as a second-line treatment option over transvaginal cerclage (TVC), it has some advantages over TVC: a higher placement of the suture at the level of the cervicoisthmic junction; avoidance of placement of foreign material in the vagina, in turn, reducing risk of infection and inflammation, which can propagate preterm labor; and the option to leave the suture in place for future pregnancies. Systematic review evidence offers TAC as a more effective procedure to TVC in reducing preterm birth and maximizing neonatal survival. Although TAC is a slightly more complex procedure compared with TVC, advances in minimally invasive surgery now allow gynecologists to perform this more effective procedure laparoscopically and therefore without the added morbidity of open surgery but with the same if not better outcomes.

Conclusions: Laparoscopic TAC can provide a more effective treatment option for CI without the added burdens of open abdominal surgery.

Relevance: Our article highlights future directions for study in the area of cervical cerclage and refinement of existing practices.