The Role of Cervical Cerclage for the Prevention of Preterm Birth: A Systematic Review

Abstract

Introduction: Cervical cerclage is a surgical procedure to place a suture around the cervix, intended to prevent preterm birth in high-risk women. This review evaluates the evidence for its efficacy based on different clinical indications.

Methods: A systematic review of RCTs was performed, analyzing trials of cerclage based on three indications: history-indicated, ultrasound-indicated (short cervix), and physical exam-indicated (dilated cervix). The primary outcome was preterm birth before 34 weeks.

Results: The review showed that history-indicated cerclage had no clear benefit. Ultrasound-indicated cerclage in women with a singleton pregnancy and a short cervix significantly reduced the risk of preterm birth. Exam-indicated ("rescue") cerclage also showed a benefit in prolonging pregnancy, though the evidence was from smaller studies.

Discussion: The efficacy of cervical cerclage is highly dependent on the indication. Its benefit is most clearly established for women with a singleton pregnancy and an ultrasound-documented short cervix.

Conclusion: Ultrasound-indicated cervical cerclage is an effective intervention for preventing preterm birth in a select high-risk population.