Transvaginal cervical cerclage: evidence for perioperative management strategies

The objective was to review the evidence supporting various perioperative technical and management strategies for transvaginal cervical cerclage. We performed MEDLINE, PubMed, EMBASE, and COCHRANE searches with the terms, cerclage, cervical cerclage, cervical insufficiency, and randomized trials, pl...

Full description

Saved in:
Bibliographic Details
Published in:American journal of obstetrics and gynecology 2013-09, Vol.209 (3), p.181-192
Main Authors: Berghella, Vincenzo, MD, Ludmir, Jack, MD, Simonazzi, Giuliana, MD, Owen, John, MD
Format: Article
Language:English
Subjects:
Amniocentesis
Anesthesia, Spinal
Anti-Bacterial Agents - therapeutic use
Cerclage, Cervical - methods
cervical cerclage
Female
Humans
Obstetrics and Gynecology
Perioperative Care
Postoperative Care
Randomized Controlled Trials as Topic
stitch
Sutures
technique
Tocolytic Agents - pharmacology
Vagina
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The objective was to review the evidence supporting various perioperative technical and management strategies for transvaginal cervical cerclage. We performed MEDLINE, PubMed, EMBASE, and COCHRANE searches with the terms, cerclage, cervical cerclage, cervical insufficiency, and randomized trials, plus each technical aspect (eg, suture, amniocentesis, etc) considered. The search spanned 1966 through September 2012 and was not restricted by language. Each retrieved manuscript was carefully evaluated, and any pertinent references from the reports were also obtained and reviewed. All randomized trials covering surgical and selected perioperative, nonsurgical aspects of cerclage were included in the review. The evidence was assessed separately for history-, ultrasound-, and physical examination-indicated cerclage. Evidence levels according to the new method outlined by the US Preventive Services Task Force were assigned based on the evidence. There are no grade A high-certainty recommendations regarding technical aspects of transvaginal cervical cerclage. Grade B moderate-certainty recommendations include performing a fetal ultrasound before cerclage to ensure fetal viability, confirm gestational age, and assess fetal anatomy to rule out clinically significant structural abnormalities; administering spinal, and not general, anesthesia; performing a McDonald cerclage, with 1 stitch, placed as high as possible; and outpatient setting. Unfortunately, no other recommendations can be made regarding the other technical aspects of cerclage.
ISSN:0002-9378
1097-6868
DOI:10.1016/j.ajog.2013.02.020