Jersey Off Shoulder Pregnancy Maternity Dress
There is insufficient evidence to recommend routine amniocentesis before rescue or
ultrasoundindicated cerclage as there are no clear data demonstrating that it improves outcome.
There are no studies to support immediate versus delayed cerclage insertion in either rescue or
ultrasound-indicated procedures, but as delay can only increase the risk of infection, immediate
insertion is likely to supersede the benefits of waiting to see if infection manifests clinically
There is an absence of data to support genital tract screening before cerclage insertion.
In the presence of a positive culture from a genital swab, a complete course of sensitive antimicrobial
eradication therapy before cerclage insertion would be recommended.
The decision for antibiotic prophylaxis at the time of cerclage placement should be at the discretion of Jersey Off Shoulder Pregnancy Maternity Dress
the operating team.
The choice of anaesthesia should be at the discretion of the operating team.
Women undergoing ultrasound-indicated or rescue cerclage, given the higher risk of complications
such as PPROM, early preterm delivery, miscarriage and infection, may benefit from at least a 24-
hour postoperative period of observation in hospital. Cases should be managed on an individual basis.
In women undergoing insertion of transabdominal cerclage via laparotomy, an inpatient stay of at
least 48 hours is recommended
The choice of suture material should be at the discretion of the surgeon
There is no current evidence to support the placement of a cervical occlusion suture in addition to the
Bed rest in women who have undergone cerclage should not be routinely recommended, but the
decision should be individualised, taking into account the clinical circumstances and the potential
adverse effects that bed rest could have on women and their families in addition to increased costs for
the healthcare system.
Abstinence from sexual intercourse following cerclage insertion should not be routinely
The decision to place a rescue cerclage following an elective or ultrasound-indicated cerclage should
be made on an individual basis, taking into account the clinical circumstances.
Routine use of progesterone supplementation following cerclage is not recommended
A transvaginal cervical cerclage should be removed before labour, usually between 36+1 and 37+0
weeks of gestation, unless delivery is by elective caesarean section, in which case suture removal could
be delayed until this time.
In women presenting in established preterm labour, the cerclage should be removed to minimize
potential trauma to the cervix.
A Shirodkar suture will usually require anaesthesia for removal.
All women with a transabdominal cerclage require delivery by caesarean section, and the abdominal
suture may be left in place following delivery
Given the risk of neonatal and/or maternal sepsis and the minimal benefit of 48 hours of latency in
pregnancies with PPROM before 23 and after 34 weeks of gestation, delayed suture removal is
unlikely to be advantageous in this situation