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ACOG Issues Guidelines on Cerclage for Managing Cervical Insufficiency — Physician’s First Watch

Medical News |
January 23, 2014

ACOG Issues Guidelines on Cerclage for Managing Cervical Insufficiency

By Amy Orciari Herman

New guidance from the American College of Obstetricians and Gynecologists outlines which women may be candidates for cervical cerclage to lower the risk for preterm birth.

The procedure may be indicated in the second trimester in women with singleton pregnancies who:

  • Have a history of second-trimester pregnancy loss associated with painless cervical dilation without labor or placental abruption;

  • Have had cerclage in a previous pregnancy due to painless dilation;

  • Currently have painless cervical dilation;

  • Previously had a spontaneous preterm birth before 34 weeks and, in the current pregnancy, have a cervical length under 25 mm before 24 weeks' gestation.

On the other hand, cerclage is not recommended for women with short cervical length in the second trimester without a history of preterm birth.

The authors note that complications associated with cerclage, while infrequent, may include rupture of membranes, chorioamnionitis, and cervical lacerations.

Reader Comments (2)

Rob Thompson, DO, MS, CPE, FAAFP Physician, Family Medicine/General Practice, Columbia,SC

Agree if ACOG guidelines are not free and accessible, they should be. Would improve managed care decision making. I am medical director for a state panel of Medicaid patients

Lois Morris, BSN, RN, CCM Other Healthcare Professional, Other, Medecision Inc.

I don’t understand why ACOG makes practice guidelines unavailable to the general public. The NEJM Journal Watch reported that “ACOG Issues Guidelines on Cerclage for Managing Cervical Insufficiency” which is important information for many of us in the health care community to know about. However, we can’t get to the source document for official referencing. This practice continues the old “doctor is God” approach where only the doctor has the “right” information in order to make treatment decisions. In this age of collaboration and partnership with patients, isn’t it time to abandon this policy?

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