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Cercalage

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"Cerclage" (likely what you meant) refers to two very different procedures depending on the medical field. Which one are you asking about?
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Which type of cerclage do you want to know about?

"Cerclage" (likely what you meant) refers to two very different procedures depending on the medical field. Which one are you asking about?
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"cervical cerclage" AND "preterm birth"

"Cerclage" (Latin cerclage = "hooping" or "encircling") is a surgical technique of encircling a structure with a band, wire, or suture to hold it together or closed. It's used in two very different contexts in medicine:

1. Cervical Cerclage (Obstetrics)

A stitch placed around the cervix to reinforce it and prevent premature dilation/opening during pregnancy, used to manage cervical insufficiency (painless cervical dilation with pregnancy loss in the 2nd or early 3rd trimester).
  • Indications: history of 3+ unexplained second-trimester losses or preterm labor from cervical insufficiency, prior cervical surgical trauma (cone biopsy, LEEP), or a short cervix found on ultrasound in a high-risk pregnancy.
  • Techniques:
    • McDonald cerclage - the most common and simplest; a purse-string suture placed at the cervicovaginal junction with monofilament suture.
    • Shirodkar cerclage - a similar but more involved technique with bladder mobilization, suture placed higher on the cervix.
    • Transabdominal cerclage - reserved for cases where transvaginal placement has failed or the cervix is too short/scarred (e.g., after prior trachelectomy).
  • Timing: ACOG guidelines recommend elective placement at 14-16 weeks' gestation after confirming fetal viability by ultrasound. It's removed around 37 weeks or with onset of labor.
  • Success rate: reported around 75-90% in women with recurrent pregnancy loss when used in a subsequent pregnancy (Pfenninger and Fowler's Procedures for Primary Care).
  • Billing: CPT 59320 (cerclage placement), 59871 (removal under anesthesia).
Recent systematic reviews/meta-analyses worth flagging:
  • A 2025 review found repeat cerclage after a failed primary cerclage may reduce pregnancy loss/preterm birth, though evidence quality is limited (PMID: 41202016).
  • Combined vaginal progesterone + cerclage may offer added benefit over cerclage alone in some populations (PMID: 37211087).
  • In twin pregnancies with short cervix or dilation, cerclage shows benefit for prolonging pregnancy and reducing adverse perinatal outcomes in select subgroups, though earlier single studies found less convincing evidence in unselected twins (PMID: 37535682).

2. Cerclage Wiring (Orthopedic Surgery)

The use of wire (or cable) looped circumferentially around a bone to hold fracture fragments together, typically as an adjunct to another fixation device (plate, nail, or screws) rather than as standalone fixation.
  • Common uses:
    • Subtrochanteric femur fracture extension during hip fracture fixation - cerclage wires stabilize a large medial or posteromedial fragment before or during nail/plate insertion.
    • Patellar fractures (tension band wiring).
    • Periprosthetic fractures around a hip or knee implant, where wires or cables secure fragments around a stem.
  • Technique notes: wires are passed subperiosteally to protect soft tissue and blood supply, then tightened and twisted or crimped. Care is taken to avoid excessive soft-tissue stripping, which risks devascularizing fragments and delaying union (Rockwood and Green's Fractures in Adults, 10th ed).
  • Often combined with a "longitudinal anterior band" technique (e.g., Lotke-Ecker technique) for patellar or periprosthetic fixation.
If you meant one of these specifically (obstetric cervical cerclage vs. orthopedic wiring) and want more depth - indications, step-by-step technique, complications, or evidence on outcomes - let me know which and I'll go deeper.
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