A review of the contemporary evidence on rescue cervical cerclage

BACKGROUND: Rescue 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. OBJECTIVES: To 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 STRATEGY: A PubMed search of published studies on RCC and perinatal outcome was conducted using defined keywords. SELECTION CRITERIA: Clinical studies were included with priority for level I evidence (randomized controlled trials [RCTs]) followed by other evidence levels. DATA COLLECTION AND ANALYSIS: Abstracts of 141 articles were screened and 40 articles were selected. MAIN RESULTS: Evidence 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. CONCLUSIONS: The decision for an RCC should be individualized after comprehensive counseling by a senior obstetrician. Further research in the form of robust RCTs is recommended.