The Shirodkar operation: A reappraisal

Management of cervical cerclage at term: remove the suture in labor?

“…No anchoring sutures are used. The Mersilene band and knot are buried by closing the mucosal incisions with a running 00 chromic suture [7]. This technique was performed electively between 13 and 18 weeks with the patients under regional anesthesia.…”

The ‘virtual’ cervical internal os: diagnosis during the first trimester of pregnancy

“…Other reasons for first‐trimester scanning of the gestational sac and the cervical internal os include: (1) verification of the proper insertion of laminaria beyond the internal os prior to first‐trimester termination; (2) diagnosis of first‐trimester placenta previa prior to laminaria insertion; (3) assessment of the location of the gestational sac in the lower (isthmic) portion of the uterus to exclude cervical pregnancy; (4) assistance during laparoscopic transabdominal cervicoisthmic cerclage in patients after cervical conization for proper placement of the cervical suture in cases of absent exocervix14; and (5) assessment of a tortuous cervical canal in an anomalous uterus to evaluate the location of cervical cerclage which was found to improve pregnancy outcome15.…”

The Incompetent Cervix — A Review

“…The stitch is removed after the thirty‐seventh completed week of gestation, or if there is rupture of membranes, bleeding per vaginam or sustained uterine contractions. Some surgeons remove the suture under epidural anaesthesia at the onset of labour 46 . This could be dangerous as the woman may be unable to present early enough in labour, or have a precipitate labour and suffer cervical laceration.…”

“…The outcome of treatment has been impressive (fetal salvage ratio >2) in most reported case series, 42,45–47 yet confidence in cervical cerclage as an efficacious method of managing cervical incompetence is not universal 29,50 and many obstetricians manage their patients simply with bed rest. Most reports in the literature are retrospective and uncontrolled, but randomisation of patients into a ‘non‐treatment’ group, when a clinical diagnosis of cervical incompetence is clear‐cut, raises ethical problems.…”