title: A review of the contemporary evidence on rescue cervical cerclage.
abstract: BACKGROUND
  Rescue cervical cerclage (RCC) is essentially a salvage procedure to prolong pregnancy in women with advanced cervical changes and prolapsed membranes in the second trimester. However, its effectiveness and safety remain controversial.
  
  
  OBJECTIVE
  To provide a comprehensive review of the contemporary evidence on RCC and evaluate which treatment modalities can be offered to pregnant women based on the best available evidence.
  
  
  METHODS
  A PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords.
  
  
  METHODS
  Clinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels.
  
  
  METHODS
  Abstracts of 141 articles were screened and 40 articles were selected.
  
  
  RESULTS
  Evidence from retrospective and nonrandomized prospective trials shows a benefit of RCC. It may prolong pregnancy by an average of 4-5 weeks, with a 2-fold reduction in the chance of preterm birth before 34 weeks. A higher chance of failure is expected if cervical dilatation exceeds 4 cm or if membranes are bulging into the vagina.
  
  
  CONCLUSIONS
  The decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Mansoura University, Mansoura, Egypt. Electronic address: hatem_ah@hotmail.com.
authors.forename: Hatem
authors.initials: H
authors.lastname: Abu Hashim
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: Al-Inany
authors.affiliation: Farah Hospital, Amman, Jordan.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Kilani
mesh_terms: D023802:Cerclage, Cervical / Q000379:methods*; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D047928:Premature Birth / Q000517:prevention & control*; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D002581:Uterine Cervical Incompetence / Q000601:surgery*
keywords: Emergency cervical cerclage; Emergent cerclage; Perinatal outcome; Rescue cerclage