Prematurity prevention: the role of cerclage.
OBJECTIVE
To summarize the literature on the value of cervical cerclage for the prevention of preterm birth and present the recent advances in its clinical application.


RESULTS
The diagnosis of cervical insufficiency is difficult as there are no objective diagnostic criteria. Although widely used, the value of cervical cerclage is still a matter of controversy. The current literature suggests that cerclage placement can prevent preterm delivery in women with a history of at least three second-trimester losses or at least three preterm births and in those with a history of prematurity who have a cervical length of less than 25 mm in the second trimester. It is also possible to improve the perinatal outcome in patients with cervical dilation in the mid-trimester. It is not indicated in multiple pregnancies, however. Further research is needed in methods of excluding inflammation in women with cervical changes on ultrasound prior to cerclage insertion. Transabdominal or laparoscopic cerclage seems to be a promising alternative in women with a history of transvaginal cerclage failure.


CONCLUSIONS
Strict recommendations on the proper use of cerclage cannot be easily made. Data from randomized trials do not support what the current practice in many cases is.
Daskalakis
George J
GJ
Division of Maternal-Fetal Medicine, First Department of Obstetrics and Gynecology, Alexandra Maternity Hospital, Athens University, Athens, Greece. gdaskalakis@yahoo.com
D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D009774:Obstetrics / Q000379:methods*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D016216:Ultrasonography, Prenatal; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000601:surgery*