GTG Cervical cerclage

Question 1

Indication for history indicated cerclage?

Answer 1

3 or more previous pre-term births

Question 2

When is serial sonographic surveillance indicated?

Answer 2

High risk women:
Previous second trimester loss or pre-term birth 16-34w
Previous PROM <34w
Previous cerclage
Known uterine variant
Intrauterine adhesions
H/O trachelectomy

Question 3

When is a history indicated cerclage inserted?

Answer 3

11-14 weeks

Question 4

At what gestation is serial sonographic surveillance performed?

Answer 4

16-24 weeks

Question 5

When should an ultrasound indicated cerclage be offered?

Answer 5

cervical length <25mm

Question 6

When is a single cervical length scan indicated?

Answer 6

Previous FD CS
Significant excisional surgery to cervix

Question 7

When should a transabdominal cerclage be considered?

Answer 7

Previous unsuccessful transvaginal cerclage
Pre-conceptually
(Preferably laparoscopically)

Question 8

When is emergency cerclage likely to fail?

Answer 8

Cervix dilated >4cm
Membrane prolapse below the external os

Question 9

When is cerclage contraindicated?

Answer 9

active pre-term labour
chorioamnionitis
PVB ongoing
PPROM
fetal compromise or lethal defect

Question 10

Should you have sex with a cerclage in situ?

Answer 10

Abstinence not routinely recommended

Question 11

When should the cerclage be removed?

Answer 11

36-37w (before labour)
If in established pre-term labour, cerclage should be removed to minimise risk of trauma to cervix