Cervical cerclage - history and contemporary use.

OBJECTIVE

Contemporary role of cerclage as a preterm birth treatment.

DESIGN

Review article.

SETTING

Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague.

METHODS

Research of existing literature, predominantly foreign journal articles, but also Czech literature and personal experience with the method.

RESULTS

Cerclage is one of the well-known surgical procedures carried out during pregnancy. Its aim is to provide a mechanical support to the cervical canal and to keep the cervix closed. The cervical mucous plug serves as a mechanical barrier between the vagina and the uterine cavity, but it also contains many immune components which protect the fetal compartment from ascendent infections. Application of a cervical stitch can help to retain the mucous plug and thus increases the immunity of the cervical canal. Results of 15 randomised studies (Cochraine Database of Systematic R) suggest that in women with increased risk of preterm birth, cerclage decreases the occurrence of preterm birth relative to the expectant management.

CONCLUSIONS

Despite the decreasing numbers of cerclage surgeries, it is still a useful method of preterm birth prevention for a specific group of women. More recently, a progesterone treatment has gained popularity. Its application, however, must begin before the 16th week of pregnancy.