The evidence for the use of cervical cerclage

Abstract

Cervical incompetence is an important factor in the aetiology of preterm birth and mid-trimester miscarriage. Its diagnosis usually relies on clinical history, but recent studies have investigated the role of transvaginal ultrasound scanning, with the finding of shortened cervical length being associated with an increased risk of preterm delivery.

Cervical incompetence can be treated using MacDonald and Shirodkar cervical sutures. The largest study to date found a significant reduction in preterm delivery in those women who had a suggestive clinical history. This finding has been supported by the insertion of sutures in women found to have a shortened cervix on ultrasound scan. These findings are inconsistent, with some studies failing to confirm benefit.

Transabdominal cervical sutures have a role in treating women with previously failed cervical cerclage (success rates reported as over 80% in most studies) although the numbers of women who have undergone this treatment is small.

Cervical sutures have been used in the management of multiple pregnancies, although to date there is no good evidence that cervical sutures have a significant role.

The use of emergency cervical sutures seems to have a role in a select population of women who present with painless cervical dilatation, in the absence of infection; in these women gestation has been prolonged by up to seven weeks.