FIGO good practice recommendations on cervical cerclage for prevention of preterm birth

Abstract

Cervical cerclage is an intervention which when given to the right women can prevent preterm birth and second‐trimester fetal losses. A history‐indicated cerclage should be offered to women who have had three or more preterm deliveries and/or mid‐trimester losses. An ultrasound‐indicated cerclage should be offered to women with a cervical length <25 mm if they have had one or more spontaneous preterm birth and/or mid‐trimester loss. In high‐risk women who have not had a previous mid‐trimester loss or preterm birth, an ultrasound‐indicated cerclage does not have a clear benefit in women with a short cervix. However, for twins, the advantage seems more likely at shorter cervical lengths (<15 mm). In women who present with exposed membranes prolapsing through the cervical os, a rescue cerclage can be considered on an individual case basis, taking into account the high risk of infective morbidity to mother and baby. An abdominal cerclage can be offered in women who have had a failed cerclage (delivery before 28 weeks after a history or ultrasound‐indicated [but not rescue] cerclage). If preterm birth has not occurred, removal is considered at 36–37 weeks in women anticipating a vaginal delivery.

Progesterone, cervical cerclage or cervical pessary to prevent preterm birth: a decision-making analysis of international guidelines

“…ACOG Practice Bulletin No.142: Cerclage for the management of cervical insufficiency [ 17 ] AWMF Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften - Guideline of the DGGG, OEGGG and SGGG 2019 Prevention and Therapy of Preterm Birth. Part 1 with Recommendations on the Epidemiology, Etiology, Prediction, Primary and Secondary Prevention of Preterm Birth [ 10 ] Part 2 with Recommendations on the Tertiary Prevention of Preterm Birth and the Management of Preterm Premature Rupture of Membranes [ 11 ] CNGOF Collège National des Gynécologues et Obstétriciens Français 2016 Prévention de la prématurité spontanée et de ses conséquences (hors rupture des membranes) [ 18 ] EAPM European Association of Perinatal Medicine 2017 Preterm Labor and Birth [ 12 ] FIGO International Federation of Gynaecology and Obstetrics 2021 FIGO good practice recommendations on cervical cerclage for prevention of preterm birth [ 14 ] FIGO good practice recommendations on progestogens for prevention of preterm delivery [ 15 ] FIGO good practice recommendations on the use of pessary for reducing the frequency and improving outcomes of preterm birth [ 13 ] JOG Japan Society of Obstetrics and Gynecology and Japan Association of Obstetricians and Gynecologists 2014 Guidelines for obstetrical practice in Japan: Japan Society of Obstetrics and Gynecology (JSOG) and Japan Association of Obstetricians and Gynecologists (JAOG) 2014 edition [ 19 ] KCE Belgian Health Care Knowledge Centre 2014 Prevention of preterm birth in women at risk: selected topics [ 20 ] NICE National Institute for Health and Care Excellence 2015 2017 2019 Preterm labour and birth NG25 [ 21 ] Surveillance report (exceptional review) 2017- Preterm labour and birth (2015) NG25 [ 22 ] Twin and triplet pregnancy NG 137 [ 23 ] SOGC Society of Obstetricians and Gynaecologists of Canada 2019 No. 373-Cervical Insufficiency and Cervical Cerclage [ ...…”

Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies – A systematic review and meta-analyses

“…Therefore, additional trials are needed to clarify the proper indications for cerclage and its relation to preterm birth prevention by investigating specific subgroups of women at risk to target the population that would benefit the most from the intervention. This is a challenging area of research since it has been a common practice in many clinics for several decades (21). A recent study comparing vaginal and abdominal cerclage for previously failed cerclage indicates an advantage for the latter (136), but further trials are needed to verify these findings.…”

“…Complications associated with the procedure are iatrogenic rupture of the membranes, vaginal bleeding, and intraamniotic infection. The transabdominal approach is mainly used after a failed vaginal cerclage or in women who have undergone a trachelectomy (radical surgery after cervical cancer) (21).…”

Cervical Cerclage vs. Pessary in Women with a Short Cervix on Ultrasound

“…spontaneous preterm birth and/or mid-trimester loss [10]. In the absence of previous history of preterm birth, however, cerclage is not advised as its benefits do not seem to be clear.…”