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Contemporary Use of Cerclage in Pregnancy

DEBBS, ROBERT H. DO, FACOOG; CHEN, JANINE MD

Clinical Obstetrics & Gynecology: December 2009 - Volume 52 - Issue 4 - pp 597-610
doi: 10.1097/GRF.0b013e3181beabaf
Surgical Intervention in Pregnancy

Second trimester pregnancy loss and preterm delivery may be considered an obstetrical syndrome. A multifactorial approach to the diagnosis of true cervical insufficiency is paramount. Surgical modification of the cervix benefits those with at least 3 second trimester losses or preterm deliveries, those with 2 early second trimester losses when no other cause for loss is identified, and those with a previous second trimester loss or preterm birth with ultrasound findings of a short cervix defined as less than 25 mm. Multifetal pregnancies do not benefit from cerclage and causes harm in those with ultrasound or physical examination identified cervical changes.

Department of Obstetrics and Gynecology, Pennsylvania Hospital, Division of Maternal Fetal Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania

Correspondence: Robert H. Debbs, DO, FACOOG. Department of Obstetrics and Gynecology, Pennsylvania Hospital Maternal Fetal Medicine Network, University of Pennsylvania School of Medicine, 800 Spruce St. Philadelphia, PA 19107. E-mail: Debbsr@pahosp.com

© 2009 Lippincott Williams & Wilkins, Inc.