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The Interpretation of ACOG Cerclage for the Management of Cervical Insufficiency
XIA En-lan
2016, 43 (6):
652-656.
Cervical incompetence (cervical insufficiency, incompetent cervix) is a clinical diagnosis disease. However, the diagnosis is very fuzzy, lack of objective gold standard. In the medical literature on cervical incompetence its pathological physiology, screening method, diagnosis and treatment is controversial. The United States in February 2014, The American College of Obstetricians and Gynecologists(ACOG) has issued guidelines of the cervical cerclage treatment for cervical incompetence, which is much strong clinical practicability. In this paper, the literature basis and the level of evidence was shown by systematic review and summary about the definition of the cervical incompetence, etiology, diagnosis, treatment options among nonsurgical and surgical modalities, the candidates should not be considered for cervical cerclage morbidity of cervical cerclage, the role of postoperative ultrasonographic assessment for additional perioperative interventions, time of remove sewing material for transvaginal McDonald cerclage indicated in patients with no complications, the time of remove out sewing silk of women with cerclage and preterm premature rupture of membranes should be managed. Should cerclage be removed in women with preterm labor etc. Points out that at present there is no guideline for the treatment of cervical incompetence in China, in general more emphasis on bed rest and cervical cerclage operation. Compared with obstetrician and gynecologist in China，European and American doctors is more careful for cervical cerclage surgery.
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