National Guideline Clearinghouse | Cervical insufficiency and cervical cerclage.
Cervical insufficiency and cervical ce... [J Obstet Gynaecol Can. 2013] - PubMed - NCBI
Society of Obstetricians and Gynaecologists of Canada
Cervical insufficiency and cervical cerclage.
|Brown R, Gagnon R, Delisle MF, Maternal Fetal Medicine Committee, Gagnon R, Bujold E, Basso M, Bos H, Brown R, Cooper S, Crane J, Davies G, Gouin K, Menticoglou S, Mundle W, Pylypjuk C, Roggensack A, Sanderson F, Senikas V. Cervical insufficiency and cervical cerclage. J Obstet Gynaecol Can. 2013 Dec;35(12):1115-27. [156 references] PubMed|
This is the current release of the guideline.
J Obstet Gynaecol Can. 2013 Dec;35(12):1115-27.
Cervical insufficiency and cervical cerclage.
Brown R1, Gagnon R1, Delisle MF2; Maternal Fetal Medicine Committee, Gagnon R1, Bujold E3, Basso M2, Bos H4, Brown R1, Cooper S5, Crane J6, Davies G7, Gouin K3, Menticoglou S8, Mundle W9, Pylypjuk C10, Roggensack A5, Sanderson F11, Senikas V12; Society of Obstetricians and Gynaecologists of Canada.
The purpose of this guideline is to provide a framework that clinicians can use to determine which women are at greatest risk of having cervical insufficiency and in which set of circumstances a cerclage is of potential value.
Published literature was retrieved through searches of PubMed or MEDLINE, CINAHL, and The Cochrane Library in 2012 using appropriate controlled vocabulary (e.g., uterine cervical incompetence) and key words (e.g., cervical insufficiency, cerclage, Shirodkar, cerclage, MacDonald, cerclage, abdominal, cervical length, mid-trimester pregnancy loss). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date or language restrictions. Searches were updated on a regular basis and incorporated in the guideline to January 2011. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Recommendations 1. Women who are pregnant or planning pregnancy should be evaluated for risk factors for cervical insufficiency. A thorough medical history at initial evaluation may alert clinicians to risk factors in a first or index pregnancy. (III-B) 2. Detailed evaluation of risk factors should be undertaken in women following a mid-trimester pregnancy loss or early premature delivery, or in cases where such complications have occurred in a preceding pregnancy. (III-B) 3. In women with a history of cervical insufficiency, urinalysis for culture and sensitivity and vaginal cultures for bacterial vaginosis should be taken at the first obstetric visit and any infections so found should be treated. (I-A) 4. Women with a history of three or more second-trimester pregnancy losses or extreme premature deliveries, in whom no specific cause other than potential cervical insufficiency is identified, should be offered elective cerclage at 12 to 14 weeks of gestation. (I-A) 5. In women with a classic history of cervical insufficiency in whom prior vaginal cervical cerclage has been unsuccessful, abdominal cerclage can be considered in the absence of additional mitigating factors. (II-3C) 6. Women who have undergone trachelectomy should have abdominal cerclage placement. (II-3C) 7. Emergency cerclage may be considered in women in whom the cervix has dilated to < 4 cm without contractions before 24 weeks of gestation. (II-3C) 8. Women in whom cerclage is not considered or justified, but whose history suggests a risk for cervical insufficiency (1 or 2 prior mid-trimester losses or extreme premature deliveries), should be offered serial cervical length assessment by ultrasound. (II-2B) 9. Cerclage should be considered in singleton pregnancies in women with a history of spontaneous preterm birth or possible cervical insufficiency if the cervical length is ≤ 25 mm before 24 weeks of gestation. (I-A) 10. There is no benefit to cerclage in a woman with an incidental finding of a short cervix by ultrasound examination but no prior risk factors for preterm birth. (II-1D) 11. Present data do not support the use of elective cerclage in multiple gestations even when there is a history of preterm birth; therefore, this should be avoided. (I-D) 12. The literature does not support the insertion of cerclage in multiple gestations on the basis of cervical length. (II-1D).
MacDonald cerclage; Shirodkar cerclage; abdominal cerclage; cervical cerclage; cervical incompetence; cervical insufficiency; cervical length; cervical shortening; prematurity; preterm delivery; rescue cerclage; trans-vaginal ultrasound
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