Cervical Cerclage: An Evolving Evidence Base

( BJOG . 2024 Nov 1;131(12):1579–1586. doi: 10.1111/1471-0528.17905. Epub 2024 Jul 4. PMID: 38962809) Preterm birth has far-reaching effects, for the child born prematurely, the families caring for these children, and the societal costs associated with preterm birth and associated disorders. Thus, prevention of preterm birth is ideal. Currently, management techniques to decrease preterm birth include progesterone supplementation, Arabin pessary, and cervical cerclage (CC). CC is a procedure where the cervical tissue is surgically reinforced with a permanent suture in an attempt to decrease early delivery or push it to a later gestational age. Although the method has been used since the 1950s, and is used commonly in practice today, questions remain about the treatment’s efficacy and appropriate patient candidates. There are concerns that patient selection may not always pick out those that can benefit from the procedure versus patients with little to no benefit from the procedure. In addition, there is some ambiguity on whether this procedure is more effective at preventing preterm birth than progesterone or pessary. This review summarizes the different usages of the procedure and reviews the evidence surrounding use of CC as a whole and differences in technique.