cerclage

Question 1

what are the indications for cerclage?

Answer 1

History indication

• 1 or more 2nd trimester pregnancy losses
• 1 or more pregnancies in which cerclage was placed for ACD

Ultrasound indicated

• history of PTB < 34 weeks
• singletone pregnancy
• CVL < 25 mm before 24 weeks

Exam indicated/rescue
- ACD in any pregnancy

Question 2

what the surgical differences in two types of transvaginal cerclage?

Answer 2

• McDonald - non-resorbable suture at cervicovaginal junction
• Shirodkar - non-resorbable suture at internal os

Neither better than the other

Question 3

When is a hx indicated cerclage best placed?

Answer 3

12-14 weeks

Question 4

When would you consider at transabdominal cerclage/cervicoisthmic cerclage?

Answer 4

• anatomic limitations (i.e. hx trachelectomy)

- prior failed transvaginal cerclage

Question 5

what is benefit of hx indicated cerclage?

Answer 5

• fewer deliveries before 33 weeks (17 vs 13%)

Question 6

what is benefit of us indicated cerclage/cervical length monitoring?

Answer 6

• reduces need for cerclage compared to hx indicated by 50%

Question 7

what is benefit of exam indicated cerclage?

Answer 7

mean prolongation of pregnancy 33 weeks, neonatal survival improves (71 vs 43%)

Question 8

do you remove cerclage for PPROM?

Answer 8

• no clear data

- if evidence of PTL or abruption or IAI, yes

Question 9

do you remove cerclage for PTL?

Answer 9

depends– if looks like truly progressing into PTL then yes

Question 10

what is US monitoring to detect CVL shortening?

Answer 10

start 16 weeks, q2 weeks until 24 weeks

Question 11

when do you schedule to remove cerclage?

Answer 11

generally 36-37 weeks. if mcdonald, can do in the office.

if scheduled CD, can do it at time of CD