ABSTRACT
Rescue cerclage is performed between 18 and 26 weeks’ gestation. The technique in this high-risk situation is difficult and should not be attempted by doctors unfamiliar with the method. The decision should be discussed with the consultant on call. The woman and her partner must be fully informed regarding the planned procedure and the risk of failure (rupture of membranes, chorioamnionitis, neonatal death and handicap), and written consent must be obtained. Prior to inserting the suture the results of an up-to-date anomaly scan should be checked to confirm that the fetus is structurally normal. An amniocentesis may need to be performed, and the amniotic fluid should be sent for microscopy and culture, and the glucose level should be checked. The woman should be treated as being at high risk of premature delivery, and consideration should be given to the use of dexamethasone at 26 and 28–30 weeks.
