Definitions Of Cervical Cerclage

Question 1

Ultrasound indicated cerclage

Answer 1

• TV scan cervical length shortening
• No fetal membranes in vagina
• Usually between 14-24 weeks
• if no previous hx there is no indication for stitch with incidental finding of short cervix 25 MM or less.
• One or more losses or preterm births who are having scans should have stitch if = 25 mm
• If funnelling cervix with no shortening then NO stitch.

Question 2

Rescue cerclage

Answer 2

• Premature cervical dilatation with exposed membranes in vagina.
• Insertion may delay delivery by 5 weeks on average
• 2 fold reduction of delivery before 34 weeks
• Risk of failure: cervix > 4 cm and membranes beyond external os
• Cerclage before 20/40 likely to result in delivery before 28 weeks

Question 3

Transvaginal cerclage - McDonald

Answer 3

Purse string suture placed at the cervicovaginal junction without bladder mobilisation

Question 4

History indicated cerclage

Answer 4

• 3 or more preterm births / second trimesters miscarriages
• Elective in asymptomatic woman at 12-14 weeks
• painless dilatation, rupture membranes before contractions, cervical surgery are NOT helpful in decision making

Question 5

High transvaginal cerclage -Shirodkar

Answer 5

Purse string like suture following bladder mobilisation to allow placement at the level of the cardinal ligaments

Question 6

Transabdominal cerclage

Answer 6

• Performed via laparotomy or laparoscopy
• Placed in the cervico ishmic junction
• It can be performed pre conceptually or in early pregnancy
• Usually inserted post extensive cervical trauma or failed transvaginal cerclage
• If miscarriage, then suction/ cut of the stitch through colpotomy/ hysterotomy may be necessary

Question 7

Occlusion cerclage

Answer 7

Occlusion of the external os with continuous non absorbable stitch for retention of mucus plug