Obstetric Cerclage.

Abstract

The purpose of this document is to provide evidence-based indications, surgical techniques, alternatives, and management strategies for cervical cerclage in pregnancy. Patients with an indication for cervical cerclage, including cervical insufficiency, prior obstetric history, and cervical shortening. This guideline was developed using an a priori protocol in conjunction with a writing team consisting of three maternal-fetal medicine subspecialists appointed by the American College of Obstetricians & Gynecologists' (ACOG's) Committee on Clinical Practice Guidelines-Obstetrics. ACOG medical librarians completed a comprehensive literature search for primary literature within Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. This Clinical Practice Guideline provides recommendations for cervical cerclage indications, surgical approach, and management, as well as alternative therapies. Recommendations are classified by strength and evidence quality.