ABSTRACT
Introduction Cervical cerclage has been extensively used for many decades to treat cervical incompetence. However, spontaneous preterm labour (SPTL) secondary to true cervical insufficiency is rare. Despite this, in all cases of SPTL regardless of the aetiology, the cervix undergoes premature effacement and dilatation resulting in a preterm birth. Cervical cerclage therefore may prevent not only cervical incompetence, but also membrane exposure, which has recently, been shown to be key to outcome. Over the past decades, there have been major advances in understanding the pathophysiology and multifactorial nature of SPTL, although there has yet to be a major impact on improving outcome. Nonetheless, improved knowledge in the area of clinical risk assessment using a tiered approach incorporating history, transvaginal ultrasound assessment of cervical length and foetal fibronectin testing has changed practice. The selective use of cervical cerclage directed at high-risk women may prove useful in influencing outcome but needs a more robust evidence base, particularly in how and whom to target.
