ACOG has published a clinical practice guideline on cervical cerclage

Today's sweep found no new obstetric or gynaecological drug action. The substantive publication is an American College of Obstetricians and Gynecologists clinical practice guideline on cervical cerclage, written by three maternal-fetal medicine subspecialists appointed by ACOG's Committee on Clinical Practice Guidelines-Obstetrics.

It was developed against an a priori protocol, with a comprehensive librarian-run literature search across Cochrane, CENTRAL, EMBASE, PubMed and MEDLINE, standardised screening, formal quality assessment and a modified GRADE evidence-to-decision framework. It covers indications for cerclage — cervical insufficiency, prior obstetric history and cervical shortening — as well as surgical approach, alternative therapies and ongoing management, with every recommendation classified by strength and evidence quality.

Cerclage is a procedure where practice has long outrun the evidence, and where the decision is frequently made under pressure with an anxious woman and a short cervix on a scan. The value of a guideline with graded recommendations is precisely that it separates what is well supported from what is customary. It is worth reading before the next such consultation rather than during it, and worth checking your unit's protocol against, particularly on the indications where the recommendation is conditional rather than strong.

• No new obstetric or gynaecological drug action in today's sweep
• New ACOG guideline covering cerclage indications, technique and alternatives
• Modified GRADE framework, with recommendations graded by strength and evidence
• Check unit protocols against it, especially where recommendations are conditional

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