Cervical Encerclage : Current Concepts

Abstract

INTRODUCTION: The American College of Obstetricians and Gynaecology dene cervical incompetence as "the inability of the uterine cervix to retain a pregnancy in the second trimester in the absence of clinical contractions, labour, or both". HISTORY: Cervical cerclage was rst proposed by Dr. Vithal Shirodkar in 1955 and the 'Shirodkar technique' was rst described by him in Bombay in 1955. This technique was modied by the Australian Gynecologist and Obstetrician, I.A. McDonald. TYPES OF CERCLAGE: Depending on the route of insertion of the stitch, cerclage can be classied into – transvaginal and transabdominal (laparoscopy or laparotomy). Arobotic approach has also been introduced recently. TYPE OF SUTURE MATERIALS: Multiple suture materials have been used to perform cervical cerclage. They can be divided into – monolament and multilament (braided) sutures. Common monolament sutures used include Nylon (Ethilon) and polypropylene (Prolene) whereas braided sutures include silk and Mersilene tape. Commonly, Mersilene tape is used by physicians because of its strength, decreased possibility of tearing through tissues and ease of removal. However, braided sutures have been associated with an increased infection rate, especially when used in contaminated surgical areas CERVICAL CERCLAGE IN PLACENTA PREVIA: The rst randomized control trial for using cerclage for management of placenta previa was conducted by Arias et al,25 patients from 24-30 weeks of gestation with the result of Cerclage patients having a signicantly better perinatal outcome by more advanced gestational age at the time of delivery, larger birth weight and fewer neonatal complications also maternal bleeding was more frequent and severe for patients in the control group CERVICAL CERCLAGE IN MULTIFETALPREGNANCY: According to RCOG green top guideline no. 60, 2011, placement of history or ultrasound indicated cervical cerclage in multifetal pregnancy is not recommended as it is associated with an increased risk of pregnancy loss and preterm delivery