ABSTRACT
Transvaginal cerclage in pregnancy was first reported in 30 women by Shirodkar in 1955. The McDonald cerclage is the most commonly performed method of cerclage. A minority of recurrent second trimester losses/births are primarily, and perhaps exclusively, caused by congenital or acquired structural weakness of the cervix and can be treated effectively with support by a “history-indicated” cerclage. Data from several studies suggest that a grossly dilated cervix with visible membranes up until 27 weeks’ gestation may be an appropriate criterion for placement of a “rescue cerclage” in some cases. Transabdominal cerclage may be successful in women who deliver very preterm despite placement of a transvaginal cerclage. Cerclage introduces a foreign body close to the mucus plug and may enhance infection. Physical examination-indicated cerclage in women with visible bulging membranes should only be considered in the absence of infection, labor, and vaginal bleeding.
