American journal of obstetrics & gynecology MFM · 2025
Guidelines on cerclage placement: a comparative systematic review.
СтатьяСистематический обзорСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mudrik Aya, Levy Romi, Petrecca Alessandro, Gulersen Moti, Chauhan Suneet P, Erez Offer, Rottenstreich Misgav
Аннотация
BACKGROUND: Variability among professional society guidelines for cervical and abdominal cerclage may lead to inconsistent clinical practice and outcomes.
OBJECTIVE: This study aimed to systematically identify, summarize, and compare professional medical-society guidelines on cervical and abdominal cerclage.
STUDY DESIGN: Guidelines were independently screened and selected by 2 reviewers. Quality was assessed using the AGREE II instrument. Data were extracted into a standardized form and synthesized narratively, focusing on comparing recommendations regarding indications, contraindications, timing, technique, and perioperative management of cerclage placement.
RESULTS: Twenty guidelines from ten professional societies were included. Consensus existed on several key indications, including history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. However, disagreements remain. For instance, ACOG (American College of Obstetricians and Gynecologists) recommends considering cerclage after one loss, whereas most guidelines require 3. There is also variation regarding the timing of physical examination cerclage beyond 24 weeks, with NICE (National Institute for Health and Care Excellence) extending the window to 28 weeks. Additionally, recommendations diverge on cerclage for prolapsed membranes, with some guidelines advising against the procedure due to a high risk of failure, while others support considering it.
CONCLUSION: Guidelines agree on history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. While agreement exists on key indications and contraindications, notable divergences remain in certain recommendations. This review emphasizes the need for congruent recommendations to enhance consistency.
OBJECTIVE: This study aimed to systematically identify, summarize, and compare professional medical-society guidelines on cervical and abdominal cerclage.
STUDY DESIGN: Guidelines were independently screened and selected by 2 reviewers. Quality was assessed using the AGREE II instrument. Data were extracted into a standardized form and synthesized narratively, focusing on comparing recommendations regarding indications, contraindications, timing, technique, and perioperative management of cerclage placement.
RESULTS: Twenty guidelines from ten professional societies were included. Consensus existed on several key indications, including history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. However, disagreements remain. For instance, ACOG (American College of Obstetricians and Gynecologists) recommends considering cerclage after one loss, whereas most guidelines require 3. There is also variation regarding the timing of physical examination cerclage beyond 24 weeks, with NICE (National Institute for Health and Care Excellence) extending the window to 28 weeks. Additionally, recommendations diverge on cerclage for prolapsed membranes, with some guidelines advising against the procedure due to a high risk of failure, while others support considering it.
CONCLUSION: Guidelines agree on history-indicated cerclage for ≥3 second-trimester losses, ultrasound-indicated cerclage for cervical lengths under 10 mm, and abdominal cerclage in cases of prior transvaginal cerclage failure or insufficient cervical tissue. While agreement exists on key indications and contraindications, notable divergences remain in certain recommendations. This review emphasizes the need for congruent recommendations to enhance consistency.