When is a cerclage indicated for cervical insufficiency? A literature review.

Cervical insufficiency is a very difficult diagnosis to confirm. An evidenced based assessment of the randomized clinical trials, meta-analysis, cohort studies and, the American College of Obstetrics and Gynecologist (ACOG) practice bulletin demonstrated there is no difference between women treated with cerclage, and those who received bed rest in patients with an appropriate history for cervical insufficiency. Based on the existing literature, cerclage is rarely, if ever mandated, but rather can be offered if the following criteria are met: (1). signs and symptoms of first trimester abnormalities in the current pregnancy are absent; (2). the patient has three or more second trimester losses (usually 18-22 weeks) with a classic history of cervical incompetence. We also recommend serial ultrasounds be performed beginning at 16 weeks to demonstrate cervical insufficiency.