Cervical cerclage (Shirodkar procedure) is indicated for which type of pregnancy loss, and when is it placed?
- A Cervical incompetence causing recurrent mid-trimester pregnancy loss; placed at 12–14 weeks ✓
- B Recurrent first-trimester miscarriage due to chromosomal causes; placed at 10 weeks
- C Placenta praevia causing painless bleeding; placed at 16 weeks
- D Preterm labor with intact membranes; placed at 24 weeks as emergency cerclage
Correct answer: A. Cervical incompetence causing recurrent mid-trimester pregnancy loss; placed at 12–14 weeks
Explanation
Cervical cerclage (McDonald or Shirodkar) is indicated for cervical incompetence, characterized by recurrent painless mid-trimester pregnancy losses (typically 14–20 weeks) due to cervical weakness without uterine contractions. History-indicated cerclage is placed electively at 12–14 weeks gestation (after first-trimester screening has confirmed a viable fetus and reduced miscarriage risk). Emergency (rescue) cerclage is placed when cervical dilatation is found incidentally before 24 weeks. Chromosomal recurrent miscarriage requires genetic counseling, not cerclage.
Reference: Williams Obstetrics, 26th ed.
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Written and medically reviewed by the StethoPrep medical team.