Cervical Cerclage: A Comprehensive Monograph on Indications, Techniques, Outcomes, and Evolving Evidence

Cervical cerclage is a surgical intervention designed to reinforce cervical integrity and prevent preterm birth (PTB) in women at high risk of cervical insufficiency. Since its introduction in the 1950s, the procedure has evolved considerably in terms of patient selection criteria, operative technique, timing, and adjunct management strategies. This monograph provides a comprehensive, evidence-based review of cervical cerclage, encompassing its historical development, pathophysiological rationale, classification of indications (history-indicated, ultrasound-indicated, and physical examination-indicated), operative approaches (McDonald, Shirodkar, and abdominal cerclage), perioperative management, outcomes, complications, and controversies. Special attention is given to the role of cervical length screening, the place of cerclage relative to competing interventions such as vaginal progesterone and cervical pessary, and the management of cerclage in multiple gestations. The monograph synthesises current evidence from randomised controlled trials, systematic reviews, and major clinical guidelines to inform contemporary obstetric practice.