210:, the least common type, is permanent and involves placing a band at the very top and outside of the cervix, inside the abdomen. This is usually only done if the cervix is too short to attempt a standard cerclage, or if a vaginal cerclage has failed or is not possible. However, a few doctors (namely Arthur Haney at the University of Chicago and George Davis at the University of Medicine and Dentistry of New Jersey) are pushing for the transabdominal cerclage (TAC) to replace vaginal cerclages, due to perceived better outcomes and more pregnancies carried to term. A
183:, described in 1957, is the most common, and is essentially a pursestring stitch used to cinch the cervix shut; the cervix stitching involves a band of suture at the upper part of the cervix while the lower part has already started to efface. This cerclage is usually placed between 16 weeks and 18 weeks of pregnancy. The stitch is generally removed around the 37th week of gestation or earlier if needed. This procedure was developed by the Australian gynecologist and obstetrician, I.A. McDonald.
159:
least several hours (sometimes overnight) to ensure that she does not go into premature labor. The patient will then be allowed to return home, but will be instructed to remain in bed or avoid physical activity (including sexual intercourse) for two to three days, or up to two weeks. Follow-up appointments will usually take place so that her doctor can monitor the cervix and stitch and watch for signs of premature labor.
40:
167:) There is no evidence that cerclage is effective in a multiple gestation pregnancy for preventing preterm births and reducing perinatal deaths or neonatal morbidity. Various studies have been undertaken to investigate whether cervical cerclage is more effective when combined with other treatments, such as antibiotics or vaginal pessary, but the evidence remains uncertain.
190:
is very similar, but the sutures pass through the walls of the cervix so they're not exposed. This type of cerclage is less common and technically more difficult than a McDonald, and is thought (though not proven) to reduce the risk of infection. The
Shirodkar procedure sometimes involves a permanent
158:
The success rate for cervical cerclage is approximately 80–90% for elective cerclages, and 40–60% for emergency cerclages. A cerclage is considered successful if labor and delivery is delayed to at least 37 weeks (full term). After the cerclage has been placed, the patient will be observed for at
270:
The Arabin
Pessary is a silicone device that has been suggested to prevent spontaneous preterm birth without the need for surgery. The leading hypotheses for its mechanisms were that it could help keep the cervix closed similarly to the cerclage, as well as change the inclination of the cervical
279:
did not result in a lower rate of spontaneous early preterm birth. Therefore, the
Society for Maternal-Fetal Medicine recommendation is that placement of cervical pessary in pregnancy to decrease preterm birth, should be used only in the context of a clinical trial or research protocol.
130:
starts to shorten and open too early during a pregnancy causing either a late miscarriage or preterm birth. In women with a prior spontaneous preterm birth and who are pregnant with one baby, and have shortening of the cervical length less than 25 mm, a cerclage prevents a
162:
For women who are pregnant with one baby (a singleton pregnancy) and at risk for a preterm birth, when cerclage is compared with no treatment, there is a reduction in preterm birth and there may be a reduction in the number of babies who die
142:
sewn into and around the cervix early in the pregnancy, usually between weeks 12 to 14, and then removed towards the end of the pregnancy when the greatest risk of miscarriage has passed. The procedure is performed under local
155:. Usually the treatment is done in the first or second trimester of pregnancy, for a woman who has had one or more late miscarriages in the past. The word "cerclage" means encircling, hooping or banding in French.
203:
in 1955. In 1963, Shirodkar traveled to NYC to perform the procedure at the New York
Hospital of Special Surgery; the procedure was successful, and the baby lived to adulthood.
935:
227:
While cerclage is generally a safe procedure, there are a number of potential complications that may arise during or after surgery. These include:
928:
214:
is required for women giving birth with a TAC. A transabdominal cerclage can also be placed pre-pregnancy if a patient has been diagnosed with an
68:
540:
1363:
1179:
921:
482:"Cervical stitch (cerclage) in combination with other treatments for preventing spontaneous preterm birth in singleton pregnancies"
687:"Use of the Arabin pessary in women at high risk for preterm birth: long-term experience at a single tertiary center in Malaysia"
1358:
415:
299:"Cerclage for short cervix on ultrasonography in women with singleton gestations and previous preterm birth: a meta-analysis"
787:"Cervical pessary placement for prevention of preterm birth in unselected twin pregnancies: a randomized controlled trial"
1368:
1332:
1062:
629:"McDonald transvaginal cervical cerclage since 1957: from its roots in Australia into worldwide contemporary practice"
405:
945:
152:
54:
1299:
563:
913:
75:
785:
Nicolaides KH, Syngelaki A, Poon LC, de Paco
Matallana C, Plasencia W, Molina FS, et al. (January 2016).
1309:
1276:
1378:
1067:
675:
Nashar, S., Dimitrov, A., Slavov, S., & Nikolov, A. (2009). Akusherstvo i ginekologiia, 48(3), 44–46.
1337:
954:
215:
123:
275:. However, large randomized clinical trials in singleton and twin pregnancies found that the cervical
1373:
1123:
1174:
1057:
975:
164:
736:
Nicolaides KH, Syngelaki A, Poon LC, Picciarelli G, Tul N, Zamprakou A, et al. (March 2016).
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47:
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139:
95:
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1003:
985:
897:
872:
713:
686:
597:
506:
481:
381:
356:
272:
828:"The role of cervical pessary placement to prevent preterm birth in clinical practice"
195:
will be necessary to deliver the baby. The
Shirodkar technique was first described by
1352:
1266:
1239:
998:
132:
662:
613:
1261:
1201:
1090:
1047:
1042:
993:
970:
771:
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448:
372:
332:
480:
Eleje GU, Eke AC, Ikechebelu JI, Ezebialu IU, Okam PC, Ilika CP (September 2020).
17:
315:
298:
81:
1304:
1229:
1107:
1052:
826:
Society for
Maternal-Fetal Medicine (SMFM) Publications Committee (March 2017).
357:"Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy"
39:
844:
827:
803:
786:
703:
433:"Cervical stitch (cerclage) for preventing preterm birth in multiple pregnancy"
246:
cervical rupture (may occur if the stitch is not removed before onset of labor)
1294:
1256:
1244:
1234:
1169:
1135:
888:
685:
Rahman RA, Atan IK, Ali A, Kalok AM, Ismail NA, Mahdy ZA, Ahmad S (May 2021).
249:
uterine rupture (may occur if the stitch is not removed before onset of labor)
144:
738:"A Randomized Trial of a Cervical Pessary to Prevent Preterm Singleton Birth"
645:
628:
584:
Mcdonald IA (June 1957). "Suture of the cervix for inevitable miscarriage".
89:
906:
853:
812:
763:
722:
654:
605:
515:
466:
390:
324:
754:
737:
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105:
1206:
276:
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canal so that the pregnancy weight is not directly above the internal
1221:
1158:
1023:
1008:
297:
Berghella V, Rafael TJ, Szychowski JM, Rust OA, Owen J (March 2011).
200:
127:
873:"Cervical stitch (cerclage) for preventing pregnancy loss in women"
258:
Cervical
Dystocia with failure to dilate requiring Cesarean Section
191:
stitch around the cervix which will not be removed and therefore a
1286:
962:
917:
586:
The
Journal of Obstetrics and Gynaecology of the British Empire
410:(1 ed.). Baltimore: Williams & Wilkins. p. 130.
883:(1). The Cochrane Collaboration, Cochrane Reviews: CD003253.
151:. It is typically performed on an outpatient basis by an
407:
Webster's New World/Stedman's
Concise Medical Dictionary
431:
Rafael TJ, Berghella V, Alfirevic Z (September 2014).
535:. Lippincott Williams & Wilkins. pp. 482–.
231:
risks associated with regional or general anesthesia
1323:
1285:
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1155:
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1104:
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1031:
1022:
984:
961:
88:
74:
62:
46:
32:
355:Alfirevic Z, Stampalija T, Medley N (June 2017).
243:infection of the amniotic sac (chorioamnionitis)
566:. American Pregnancy Association. 26 April 2012
350:
348:
346:
344:
342:
929:
832:American Journal of Obstetrics and Gynecology
791:American Journal of Obstetrics and Gynecology
532:Five-minute obstetrics and gynecology consult
8:
871:Drakeley AJ, Roberts D, Alfirevic Z (2003).
877:The Cochrane Database of Systematic Reviews
486:The Cochrane Database of Systematic Reviews
437:The Cochrane Database of Systematic Reviews
361:The Cochrane Database of Systematic Reviews
135:and reduces death and illness in the baby.
1028:
936:
922:
914:
529:Paula J. Adams Hillard, ed. (1 May 2008).
38:
896:
843:
802:
753:
712:
702:
644:
505:
456:
380:
314:
289:
29:
7:
944:Tests and procedures involving the
742:The New England Journal of Medicine
175:There are three types of cerclage:
138:The treatment consists of a strong
101:
598:10.1111/j.1471-0528.1957.tb02650.x
25:
627:Goulding E, Lim B (August 2014).
252:injury to the cervix or bladder
498:10.1002/14651858.CD012871.pub2
449:10.1002/14651858.CD009166.pub2
373:10.1002/14651858.CD008991.pub3
237:premature rupture of membranes
1:
691:BMC Pregnancy and Childbirth
316:10.1097/aog.0b013e31820ca847
27:Obstetrics medical procedure
1333:Gynecologic ultrasonography
1063:Uterine artery embolization
1395:
1364:Health issues in pregnancy
946:female reproductive system
845:10.1016/j.ajog.2017.01.006
804:10.1016/j.ajog.2015.08.051
704:10.1186/s12884-021-03838-x
261:displacement of the cervix
55:obstetrics and gynaecology
1300:Female genital mutilation
952:
889:10.1002/14651858.CD003253
303:Obstetrics and Gynecology
153:obstetrician-gynecologist
102:
37:
1310:Clitoral hood reduction
1277:Vaginal transplantation
646:10.1111/1471-0528.12874
240:infection of the cervix
147:, usually by way of a
1359:Gynecological surgery
1338:Hysterosalpingography
955:Gynecological surgery
755:10.1056/NEJMoa1511014
122:, is a treatment for
1124:Endometrial ablation
1369:Implants (medicine)
1175:Cervical conization
1058:Pelvic exenteration
976:Salpingoophorectomy
564:"Cervical Cerclage"
165:perinatal mortality
1192:Cervical screening
1147:Uterine myomectomy
1119:Endometrial biopsy
404:Stedman T (1987).
216:incompetent cervix
208:abdominal cerclage
188:Shirodkar cerclage
118:, also known as a
18:Cerclage, cervical
1346:
1345:
1272:Vaginal wet mount
1216:
1215:
1187:Cervical cerclage
1096:Vacuum aspiration
748:(11): 1044–1052.
542:978-0-7817-6942-6
193:Caesarean section
181:McDonald cerclage
124:cervical weakness
116:Cervical cerclage
113:
112:
33:Cervical cerclage
16:(Redirected from
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797:(1): 3.e1–3.e9.
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492:(9): CD012871.
479:
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443:(9): CD009166.
430:
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403:
402:
398:
367:(6): CD008991.
354:
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234:premature labor
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197:V. N. Shirodkar
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120:cervical stitch
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1080:Uterine cavity
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1037:
1026:
1020:
1019:
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1016:
1014:Tubal reversal
1011:
1006:
1004:Tubal ligation
1001:
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838:(3): B8–B10.
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19:
1262:Colpocleisis
1202:Cervicectomy
1186:
1157:
1134:
1106:
1091:Hysteroscopy
1078:
1048:Hysterectomy
1043:Genitoplasty
1033:
994:Falloposcopy
971:Oophorectomy
880:
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835:
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568:. Retrieved
558:
546:. Retrieved
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266:Alternatives
226:
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187:
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149:spinal block
137:
119:
115:
114:
1374:Miscarriage
1305:Labiaplasty
1230:Vaginectomy
1108:Endometrium
1053:Hysterotomy
639:(9): 1107.
145:anaesthesia
126:, when the
1353:Categories
1295:Vulvectomy
1257:Hymenotomy
1245:Episiotomy
1235:Culdoscopy
1170:Colposcopy
1136:Myometrium
697:(1): 368.
570:2013-06-27
548:5 November
417:0139481427
284:References
1209:insertion
212:c-section
90:eMedicine
48:Specialty
1196:pap test
1034:General:
907:12535466
854:28108157
813:26321037
764:26981934
723:33971828
663:21004646
655:25047486
614:73159712
606:13449654
516:32970845
467:25208049
458:10629495
391:28586127
325:21446209
255:bleeding
64:ICD-9-CM
1207:Pessary
963:Ovaries
898:6991153
772:2957739
714:8108362
507:8094629
382:6481522
333:7509348
277:pessary
96:1848163
82:D023802
1222:Vagina
1159:Cervix
1024:Uterus
1009:Essure
905:
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331:
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201:Bombay
140:suture
128:cervix
1287:Vulva
768:S2CID
659:S2CID
610:S2CID
329:S2CID
223:Risks
171:Types
104:[
1180:LEEP
903:PMID
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365:2017
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885:doi
840:doi
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