TY - JOUR
T1 - Guidelines on cerclage placement
T2 - a comparative systematic review
AU - Mudrik, Aya
AU - Levy, Romi
AU - Petrecca, Alessandro
AU - Gulersen, Moti
AU - Chauhan, Suneet P.
AU - Erez, Offer
AU - Rottenstreich, Misgav
N1 - Publisher Copyright:
© 2025 The Author(s)
PY - 2025/9/1
Y1 - 2025/9/1
N2 - 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.
AB - 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.
KW - cervical cerclage
KW - cervical insufficiency
KW - practice guidelines
KW - preterm birth prevention
KW - systematic review
UR - https://www.scopus.com/pages/publications/105010934295
U2 - 10.1016/j.ajogmf.2025.101727
DO - 10.1016/j.ajogmf.2025.101727
M3 - Review article
C2 - 40541862
AN - SCOPUS:105010934295
SN - 0002-9378
VL - 7
JO - American Journal of Obstetrics and Gynecology MFM
JF - American Journal of Obstetrics and Gynecology MFM
IS - 9
M1 - 101727
ER -