O&G Cases · Gynae-surgery — cervical insufficiency and preterm birth prevention
Rescue cerclage for a dilated cervix — emergency management station
Procedural decision station: examination-indicated (rescue) cerclage. Tests the exclusion of labour and infection before theatre, membrane reduction, the technique and tocolysis, and the counselling of a woman with a threatened second-trimester loss. Includes assessor key and marking domains.
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Target exams
Station brief
Format. Procedural decision station, approximately 12 minutes. You are the obstetric registrar on the labour ward. A midwife and a junior doctor are with you; the consultant has been called and is 15 minutes away. The assessor runs the clock and feeds new findings. [1]
Candidate instruction. Assess the woman, decide whether a rescue cerclage is appropriate, prepare for theatre, and verbalise the technique, the contraindications you exclude, and your communication with the team and the woman. [1][2]
References4ShowHide
- [1]Shennan AH, Story L Cervical Cerclage: Green-top Guideline No. 75 BJOG, 2022.PMID 35199905
- [2]Ehsanipoor RM, Seligman NS, Saccone G, et al. Physical Examination-Indicated Cerclage: A Systematic Review and Meta-analysis Obstet Gynecol, 2015.PMID 26241265
- [3]Shennan A, Chandiramani M, Bennett P, et al. MAVRIC: a multicenter randomized controlled trial of transabdominal vs transvaginal cervical cerclage Am J Obstet Gynecol, 2020.PMID 31585096
- [4]Hodgetts Morton V, Toozs-Hobson P, Moakes CA, et al. Monofilament suture versus braided suture thread to improve pregnancy outcomes after vaginal cervical cerclage (C-STICH): a pragmatic randomised, controlled, phase 3, superiority trial Lancet, 2022.PMID 36273481