A review of the contemporary evidence on rescue cervical cerclage

Background

Rescue cervical cerclage (RCC) is essentially a salvage procedure to prolong pregnancy in women with advanced cervical changes and prolapsed membranes in the second trimester. However, its effectiveness and safety remain controversial.

Objectives

To provide a comprehensive review of the contemporary evidence on RCC and evaluate which treatment modalities can be offered to pregnant women based on the best available evidence.

Search strategy

A PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords.

Selection criteria

Clinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels.

Data collection and analysis

Abstracts of 141 articles were screened and 40 articles were selected.

Main results

Evidence from retrospective and nonrandomized prospective trials shows a benefit of RCC. It may prolong pregnancy by an average of 4–5 weeks, with a 2-fold reduction in the chance of preterm birth before 34 weeks. A higher chance of failure is expected if cervical dilatation exceeds 4 cm or if membranes are bulging into the vagina.

Conclusions

The decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.