Contemporary use of cerclage in pregnancy.
Second trimester pregnancy loss and preterm delivery may be considered an obstetrical syndrome. A multifactorial approach to the diagnosis of true cervical insufficiency is paramount. Surgical modification of the cervix benefits those with at least 3 second trimester losses or preterm deliveries, those with 2 early second trimester losses when no other cause for loss is identified, and those with a previous second trimester loss or preterm birth with ultrasound findings of a short cervix defined as less than 25 mm. Multifetal pregnancies do not benefit from cerclage and causes harm in those with ultrasound or physical examination identified cervical changes.
Debbs
Robert H
RH
Department of Obstetrics and Gynecology, Pennsylvania Hospital, Division of Maternal Fetal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19107, USA. Debbsr@pahosp.com
Chen
Janine
J
D000026:Abortion, Habitual; D023802:Cerclage, Cervical / Q000379:methods; D002584:Cervix Uteri / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005322:Premature Rupture of Fetal Membranes; D006801:Humans; D010808:Physical Examination; D011247:Pregnancy; D011256:Pregnancy Outcome; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control; D014463:Ultrasonography; D002581:Uterine Cervical Incompetence / Q000000981:diagnostic imaging / Q000601:surgery