[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-390389-105":59,"doc-detail-390389-en":135},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":128,"head_meta":130,"extra_data":132,"updated_unix":134},105,"en","smfm-consult-series-consult-series-65-transabdominal-cerclage","SMFM Consult Series - Consult Series #65 - Transabdominal Cerclage","","Society for Maternal-Fetal Medicine (SMFM) presents Consult Series #65 on transabdominal cerclage for cervical insufficiency. It reviews literature on benefits and risks versus transvaginal cerclage, highlighting increased morbidity and the likelihood of cesarean delivery. SMFM provides graded recommendations on candidate selection, timing before pregnancy or in the first trimester, acceptable surgical approaches, counseling, and follow-up care, including guidance on progesterone discussions, pregnancy loss management, and cesarean timing.",{"@graph":69,"@context":127},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/smfm-consult-series-consult-series-65-transabdominal-cerclage/390389/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/smfm-consult-series-consult-series-65-transabdominal-cerclage/390389.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-29","2026-09-25",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",15,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119,123],{"name":110,"@type":111,"acceptedAnswer":112},"What is transabdominal cerclage recommended for in patients with prior cerclage history?","Question",{"text":113,"@type":114},"SMFM recommends offering transabdominal cerclage placement to patients with a previous transvaginal cerclage placement (history or ultrasound indicated) who then have a subsequent spontaneous singleton delivery before 28 weeks of gestation (GRADE 1B).","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"When can transabdominal cerclage be performed, and what if presentation occurs after the first trimester?",{"text":118,"@type":114},"SMFM suggests it can be performed before pregnancy or in the first trimester with similar fetal outcomes. If indicated patients present after the first trimester, transabdominal cerclage can still be considered before 22 weeks of gestation (GRADE 2C).",{"name":120,"@type":111,"acceptedAnswer":121},"Is routine transvaginal cervical length screening advised for patients with a transabdominal cerclage in situ?",{"text":122,"@type":114},"SMFM recommends that routine transvaginal cervical length screening not be performed for patients with a transabdominal cerclage in situ (GRADE 1C).",{"name":124,"@type":111,"acceptedAnswer":125},"What cesarean delivery timing does SMFM suggest for patients with a transabdominal cerclage in situ?",{"text":126,"@type":114},"SMFM suggests cesarean delivery between 37 0/7 and 39 0/7 weeks of gestation for patients with a transabdominal cerclage in situ (GRADE 2C).","https://schema.org",{"og:url":83,"og:type":129,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":131,"canonical":83},"index,follow",{"doc_id":133,"site_id":62},390389,1790532415,{"code":4,"msg":5,"data":136},{"doc_id":133,"user_id":137,"nickname":92,"user_avatar":138,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":139,"file_id":140,"file_url":141,"file_type":142,"file_size":143,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":44,"language":144,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":145,"faqs":146,"seo_title":147,"seo_description":67,"update_tm":148,"read_time":149,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","SMFM Consult Series  \n[smfm.org](smfm.org)  \nSociety for Maternal-Fetal Medicine   \nConsult Series \\#65: Transabdominal cerclage  \nSociety for Maternal-Fetal Medicine (SMFM); Lorene Temming, MD, MSCI; and Emad Mikhail, MD; SMFM Publications Committee  \nThe American Association of Gynecologic Laparoscopists (AAGL) and the American College of Obstetricians and Gynecologists (ACOG) endorse this document.  \nCerclage is the mainstay of treatment for cervical insufficiency. Although transabdominal cerclage may have advantages over transvaginal cerclage, it is associated with increased morbidity and the need for cesarean delivery. In this Consult, we review the current literature on the benefits and risks of transabdominal cerclage and provide recommendations based on the available evidence. The following are Society for Maternal-Fetal Medicine recommendations: (1) we recommend that transabdominal cerclage placement be offered to patients with a previous transvaginal cerclage placement (history or ultrasound indicated) and subsequent spontaneous singleton delivery before 28 weeks of gestation (GRADE 1B); (2) we recommend maternal-fetal medicine consultation for counseling patients who maybe candidates for transabdominal cerclage and those who have undergone transabdominal cerclage (Best Practice); (3) we suggest that both laparoscopic transabdominal cerclage and open transabdominal cerclage are acceptable and the decision of approach may depend on gestational age, technical feasibility, available resources, and expertise (GRADE 2B); (4) we suggest that transabdominal cerclage can be performed before pregnancy or in the first trimester of pregnancy with similar fetal outcomes. If a patient with an indication for transabdominal cerclage presents after the first trimester of pregnancy, transabdominal cerclage can still be considered before 22 weeks of gestation (GRADE 2C);  \n(5) we recommend that routine transvaginal cervical length screening not be performed for patients with a transabdominal cerclage in situ (GRADE 1C); (6) we suggest that for individuals at risk of recurrent spontaneous preterm birth, including those with a transabdominal cerclage in situ, a risk-benefit discussion of supplemental vaginal progesterone be undertaken with shared decision-making (GRADE 2C);  \n(7) we suggest that pregnancy loss be managed with dilation and curettage or dilation and evacuation with a transabdominal cerclage in situ or via usual obstetrical management after laparoscopic removal of the transabdominal cerclage, depending on gestational age and resources available (GRADE 2C);and (8) we suggest cesarean delivery between 37 0/7 and 39 0/7 weeks of gestation for patients with a transabdominal cerclage in situ (GRADE 2C) .  \nKey words: cervical insufficiency, laparoscopic transabdominal cerclage, preterm birth, transabdominal cerclage  \nIntroduction  \nPreterm birth remains a leading cause of neonatal morbidity and mortality. Cervical insufficiency, commonly defined asthe inability of a cervix to retain a pregnancy, is an important cause of preterm birth.1 Cervical insufficiency complicates 0.05% to 1.00% of pregnancies and is characterized by painless cervical dilation leading to early delivery, typically in the middle of the second trimester of pregnancy.2 The underlying physiology of cervical insufficiency is poorly understood. There are several innate risk factors for cervical  \nCorresponding author: Society for Maternal-Fetal Medicine (SMFM) [Publications Committee.](Publications Committee. pubs@smfm.org)[ pubs@smfm.org](Publications Committee. pubs@smfm.org)  \nB2 JUNE 2023  \ninsufficiency, including müllerian anomalies and diseases with abnormal collagen, such as Ehlers-Danlos syndrome. In addition, various acquired risk factors for cervical insufficiency have been described, including cervical trauma, prolonged second stage of labor, repeated mechanical dilation, and loop electrosurgery excision procedures (LEEPs) or cold knife conization procedures.1 ","cbCaialGt6YXBE18","https://ap.wps.com/l/cbCaialGt6YXBE18","pdf",281844,"English","# Introduction\n## Clinical context and diagnosis\n## Treatment options and evidence\n## Cerclage techniques and indications","[{\"question\":\"What is transabdominal cerclage recommended for in patients with prior cerclage history?\",\"answer\":\"SMFM recommends offering transabdominal cerclage placement to patients with a previous transvaginal cerclage placement (history or ultrasound indicated) who then have a subsequent spontaneous singleton delivery before 28 weeks of gestation (GRADE 1B).\"},{\"question\":\"When can transabdominal cerclage be performed, and what if presentation occurs after the first trimester?\",\"answer\":\"SMFM suggests it can be performed before pregnancy or in the first trimester with similar fetal outcomes. If indicated patients present after the first trimester, transabdominal cerclage can still be considered before 22 weeks of gestation (GRADE 2C).\"},{\"question\":\"Is routine transvaginal cervical length screening advised for patients with a transabdominal cerclage in situ?\",\"answer\":\"SMFM recommends that routine transvaginal cervical length screening not be performed for patients with a transabdominal cerclage in situ (GRADE 1C).\"},{\"question\":\"What cesarean delivery timing does SMFM suggest for patients with a transabdominal cerclage in situ?\",\"answer\":\"SMFM suggests cesarean delivery between 37 0/7 and 39 0/7 weeks of gestation for patients with a transabdominal cerclage in situ (GRADE 2C).\"}]","SMFM Consult Series - Consult Series #65 - Transabdominal Cerclage | PDF",1790333760,23]