GTG Cervical cerclage Flashcards
Indication for history indicated cerclage?
3 or more previous pre-term births
When is serial sonographic surveillance indicated?
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
When is a history indicated cerclage inserted?
11-14 weeks
At what gestation is serial sonographic surveillance performed?
16-24 weeks
When should an ultrasound indicated cerclage be offered?
cervical length <25mm
When is a single cervical length scan indicated?
Previous FD CS
Significant excisional surgery to cervix
When should a transabdominal cerclage be considered?
Previous unsuccessful transvaginal cerclage
Pre-conceptually
(Preferably laparoscopically)
When is emergency cerclage likely to fail?
Cervix dilated >4cm
Membrane prolapse below the external os
When is cerclage contraindicated?
active pre-term labour
chorioamnionitis
PVB ongoing
PPROM
fetal compromise or lethal defect
Should you have sex with a cerclage in situ?
Abstinence not routinely recommended
When should the cerclage be removed?
36-37w (before labour)
If in established pre-term labour, cerclage should be removed to minimise risk of trauma to cervix
Average interval between PPROM and delivery?
7 days
In the ORACLE trial, erythromycin in PPROM improved which outcomes?
Reduction in chorioamnionitis, neonatal infection, need for surfactant
What do swabs to asses for SROM detect?
insulin-like growth factor protein (IGFBP-1)
OR placental alpha microglobulin-1 (PAMG-1)
Emergency cerclage may delay labour by how many days?
34 days on average
