The scientific basis of cervical encirclage involves several key aspects:

• Cervical anatomy and physiology: The cervix plays a crucial role in maintaining a closed and sealed environment during pregnancy. It is composed of strong connective tissues and a thick layer of cervical mucus that acts as a physical barrier to prevent premature opening or dilation. Cervical incompetence occurs when the cervix is weakened or structurally compromised, potentially leading to preterm labor or miscarriage.
• Patient selection and diagnostic criteria: Women with a history of previous preterm birth or cervical incompetence, as well as those with specific anatomical or structural abnormalities of the cervix, may be candidates for the procedure. Diagnostic tests such as transvaginal ultrasound, cervical length measurement, and clinical evaluation help identify individuals who would benefit from cervical encirclage.
• Surgical techniques: Cervical encirclage is performed by placing a suture around the cervix to provide mechanical reinforcement and support. The two main techniques used are the McDonald technique and the Shirodkar technique. The McDonald technique involves placing a non-absorbable suture around the cervix in a purse-string fashion. The Shirodkar technique involves creating a small incision in the anterior cervix to create a tunnel, through which a suture is passed and tied to provide cervical support. The choice of technique depends on individual patient characteristics and surgeon preference.
• Timing of the procedure: The scientific basis of cervical encirclage also considers the optimal timing for performing the procedure. The timing may vary based on individual patient factors, such as the presence of cervical changes or a history of preterm birth. Cervical encirclage is typically performed between 12 and 24 weeks of gestation, but it can be considered earlier in some cases.
• Efficacy and outcomes: Scientific evidence supports the efficacy of cervical encirclage in reducing the risk of preterm birth and improving pregnancy outcomes in women with cervical incompetence. The procedure provides mechanical reinforcement to the weakened cervix, helping to maintain its integrity and reducing the likelihood of premature cervical dilation. Studies have shown that cervical encirclage can significantly prolong pregnancy and reduce the incidence of preterm birth in eligible patients.
• Potential risks and complications: Like any surgical procedure, cervical encirclage carries potential risks and complications. These may include infection, bleeding, cervical trauma, premature rupture of membranes, and preterm labor. The scientific basis of cervical encirclage involves a thorough assessment of the individual patient's risks and benefits to minimize complications and optimize outcomes.