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Cervical Cerclage (Green-top Guideline No. 60)

Published: 19/05/2011

This is the first edition of this guideline.

December 2014: New evidence and guidance in this field were reviewed in 2014 and it was decided that revision of this guideline would be deferred to a later date. The version available on the website and app will remain valid until replaced.

Over the last 50 years the use of cerclage has expanded to the management of women considered to be at high risk of mid-trimester loss and spontaneous preterm birth by virtue of factors such as multiple pregnancy, uterine anomalies, a history of cervical trauma (e.g. conisation or operations requiring forced dilatation of the cervical canal), and cervical shortening seen on sonographic examination. However its use and efficacy in these different groups is highly controversial since there is contradiction in the results of individual studies and meta-analyses.

Cerclage remains a commonly performed prophylactic intervention used by most obstetricians despite the absence of a well-defined population for whom there is clear evidence of benefit. Furthermore, there is little consensus on the optimal cerclage technique and timing of suture placement. The role of amniocentesis prior to emergency (rescue) cerclage insertion and the optimal management following insertion are also poorly defined. Complications are not well documented and often difficult to separate from risks inherent to the underlying condition. The purpose of this guideline is to review the literature and provide evidence-based guidance on the use of cerclage.