Current controversies in cervical cerclage

Cervical incompetence is defined as the inability to support a full-term pregnancy because of a functional or structural defect of the cervix. It is characterized clinically by acute, painless dilatation of the cervix usually in the mid-trimester culminating in prolapse and/or premature rupture of the membranes with resultant preterm and often previable delivery. Cervical cerclage has become the mainstay for the management of cervical incompetence, but remains one the more controversial surgical interventions in obstetrics. This article reviews the current state of the literature as regards the indications, contraindications, and techniques of cervical cerclage. This article also focuses in detail on 4 areas of controversy, namely transabdominal cerclage, cervical cerclage for a short cervix, the management of cerclage after preterm premature rupture of the membranes, and the utility of a second (salvage) cerclage. Copyright 2003, Elsevier Science (USA). All rights reserved.