GUIA ACOG CERCLAJE

1. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY
The American College of
Obstetriciansand Gynecologists
WOMEN’S HEALTH CARE PHYSICIANS
Traducido del inglés al español: Dr. Pedro Vargas Torres.
Medico Especialista en Obstetricia y Ginecología
Hospital Universitario Dr. Pedro EmilioCarrillo de Valera – Estado Trujillo. Venezuela.
Profesorde Obstetricia y Ginecología Universidad de Los Andes – Venezuela.

2. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY
The American College of
Obstetriciansand Gynecologists
WOMEN’S HEALTH CARE PHYSICIANS
ó
í

3. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY

Cuadro 1. Indicacionesparael Cerclaje Cervical
en MujeresCon Embarazos Únicos ←
Antecedentes
• Historia de una o más perdidas gestacionales en el
segundo trimestre relacionadas con dilatación cervical sin
dolor y en ausencia de trabajo de parto o desprendimiento
prematuro de placenta (abruptio placentae)
• Cerclaje previo debido a dilatación cervical sin dolor en el
segundo trimestre
Exploración Física
• Dilatación cervical sin dolor en el segundo trimestre
Hallazgos EcográficosCon unaHistoria de Parto
Prematuro Previo
• Embarazo único actual, con nacimiento prematuro
espontaneo previo de menos de 34 semanas de gestación, y
que la longitud del cuello uterino sea corta (menos de 25
mm) antes de las 24 semanas de gestación.

4. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY
ó í



5. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY







6. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY













7. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY

8. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY

9. VOL.123, NO.2, PART 1, FEBRUARY 2014 OBSTETRICS& GYNECOLOGY
The MEDLINEdatabase,theCochraneLibrary, and the
AmericanCollege ofObstetricians andGynecologists’
own internalresources anddocuments were used to
conduct a literaturesearch tolocaterelevant articles
publishedbetweenJanuary 2000–June2013. The
searchwas restrictedto articles publishedin the
English language. Priority was givento articles
reporting results oforiginalresearch, although review
articles and commentaries also wereconsulted.
Abstracts ofresearch presentedat symposia and
scientificconferences werenotconsidered adequate
for inclusion in this document. Guidelines published by
organizations or institutions such as theNation al
Institutes ofHealthand the American Collegeof
Obstetricians and Gynecologists werereviewed,and
addition alstudies were locatedby review ing
bibliographies ofidentified articles. Whenreliable
researchwas not available, expert opinions fromobste
trician–gynecologists were used.Studies were
reviewedand evaluatedfor quality according tothe
method outlined by the U.S.PreventiveServices Task
Force:
I Evidence obtainedfrom at least oneproperly de
signed randomizedcontrolledtrial.
II-1 Evidenceobtained fromwell-designed controlled
trials without randomization.
II-2 Evidenceobtained fromwell-designed cohort or
case–control analytic studies, prefer a bly frommore
than one centeror research group.
II-3 Evidenceobtained frommultiple time series with
or with out theintervention. Dramatic results in un
controlledex periments alsocould beregarded as this
type of evidence.
III Opinions of respected authorities,basedon clinical
experience,descriptivestudies,or reports ofexpert
committees.
Based on the highest levelofevidencefoundin the
data, recommendations areprovidedandgraded
according to the following categories:
Level A—Recommendations are based ongood and
consistent scientificevidence.
Level B—Recommendations arebasedon limited or
inconsistent scientificevidence.
Level C—Recommendations arebasedprimarily on
consensus and expertopinion.