Conclusion
The Shirodkar cerclage technique achieves greater cerclage height and
longer interval between time at cerclage insertion to delivery, leading
to increased birthweight and a reduction in PPROM and PTB when compared
to the McDonald approach. By choosing the Shirodkar technique rather
than the McDonald technique, one additional preterm birth would be
prevented for every 38 cerclage procedures. Clinicians should consider
these results when deciding which cerclage technique to utilise;
however, further unbiased high-quality studies are needed to provide
stronger supporting evidence that the Shirodkar approach has the
potential to achieve better outcomes when compared to the McDonald
approach. We recommend that obstetricians in training should be taught
both surgical approaches where possible and decisions about which
technique to use should be individualised to the woman.