A review of the contemporary evidence on rescue cervical cerclage

BackgroundRescue 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.ObjectivesTo 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 strategyA PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords.Selection criteriaClinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels.Data collection and analysisAbstracts of 141 articles were screened and 40 articles were selected.Main resultsEvidence 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.ConclusionsThe decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.