Which of the following investigations are essential before cervical cerclage is performed?
Ans. is d, i.e. Perform an ultrasound scan for fetal abnormalities and screen for aneuploidy Before answering the question lets discuss a few details on cervical cerclage surgery.Nomenclature for cerclage applicationOld (1999)New (2007)Prophylactic, electiveHistory indicatedTherapeutic, salvageUltrasound indicatedRescue, emergency urgentPhysical examination indicatedRecommendations for history indicated cerclageShould be offered to women with 3 or more previous preterm births and/or second trimester lossesShould not be routinely offered to women with two or fewer previous preterm birth and/or second trimester losses (Level B evidence)Recommendations for USG indicated cerclageWomen with history of 1 or more spontaneous preterm births or/mid trimester losses with Y, V or U detected on USG or cervical length <25mm before 24 weeks-Not recommended for women without a history of spontaneous preterm delivery or second trimester losses with incidentally detected cervical length <=25mm-Not recommended for funneling of cervix in the absence of cervical shortening to <=25mm A cervical cerclage should be carried out in her as she has H/O 3 previous preterm deliveries.An ultrasound scan for fetal abnormalities and screening for aneuploidy should be carried out, before insertion of a history- indicated suture, to ensure both viability and the absence of lethal/major fetal abnormalities. Assessment of cervical length is not indicated before applying a history indicated cerclage. It is not essential to perform a white cell count or C-reactive protein levels before performing a cervical cerclage.
Estimate C-reactive protein levels
Perform a white cell count
Perform a transvaginal ultrasound scan to assess the cervical length and exclude funnelling
Perform an ultrasound scan for fetal abnormalities and screen for aneuploidy
Normal Labour