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OBJECTIVE: Cervical cerclage has been used for decades for prevention of preterm birth; no consensus regarding optimal surgical technique exists. This review assesses if Shirodkar's technique (bladder dissection) is superior to McDonald's (without dissection) with respect to pregnancy loss and maternal-fetal outcomes. A secondary aim is to assess potential benefits of double cerclage. METHODS: Systematic review was conducted, PROSPERO protocol (CRD42023472563). MEDLINE, Embase, CINAHL and Cochrane Library were searched. 1647 abstracts were screened, 22 studies met inclusion criteria. Bias was assessed using ROBINS-I and ROB2 and meta-analysis conducted using RevMan. RESULTS: 35%). CONCLUSIONS: No difference in odds of pregnancy loss was evident between surgical techniques, however dissection was associated with prolongation of pregnancy by 2 weeks and reduced odds of birth <32 weeks. Double cerclage may provide additional benefits in prevention of preterm birth. Overall quality of evidence is low.Choice of technique should be informed by obstetric history, clinical examination, and clinician preference.
Vaughan et al. (Wed,) studied this question.
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