section name header

Table 6-1

Indications for Cerclagea

Indication TypeHistory-Indicated (“Prophylactic”)Physical Examination–Indicated (“Emergency” or “Rescue”)Ultrasound-Indicated
Clinical requirements

  • History of one or more second-trimester pregnancy losses related to painless cervical dilationb

  • Prior cerclage due to painless cervical dilation in second trimester

  • Painless cervical dilation in second trimester without evidence of preterm labor or placental abruptionc,d

  • Cervical length <25 mm in patient with history of PTB less than 34 wk gestation and current singleton pregnancy before 24 wk of gestatione,f

Timing and placement considerations

  • Place at 13-14 wk gestation

  • Place at time of diagnosis

  • Must rule out PTL and intraamniotic infection

  • Place at time of diagnosis

  • If patient on 17-P, continue weekly therapy until 36 wk.

Abbreviations: PTB, preterm birth; PTL, preterm labor; 17-P, 17-α hydroxyprogesterone caproate.


aAdapted with permission from American College of Obstetricians and Gynecologists Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 142: cerclage for the management of cervical insufficiency. Obstet Gynecol. 2014;123(2 Pt 1):372-379. (Reaffirmed 2019). Copyright © 2014 by The American College of Obstetricians and Gynecologists.
bData is mixed regarding benefit of cerclage in this population.
cMay consider indomethacin and antibiotics for placement: cefazolin 1-2 g preoperatively and every 8 h × 2 (clindamycin 600 mg if penicillin allergy); indomethacin 50 mg postprocedure and every 8 h × 2.
dPossible benefit of cerclage in this population; however, no randomized control trials have been performed that demonstrate clear benefit.
eMeta-analysis has shown cerclage is beneficial in this population.
fCerclage for shortened cervical length on ultrasound is not clearly indicated in women without history of PTB (see “Progesterone Therapy”).