Standardized perioperative terminology for emergency cervical cerclage: A framework for feasibility and procedural complexity assessment
- 1Department of Obstetrics and Gynecology, Cervical Insufficiency Center Dongtan Jeil Women's Hospital Hwaseong Republic of Korea
- 2Department of Obstetrics and Gynecology Hanyang University Hospital Seoul Republic of Korea
Abstract
Introduction: Emergency cervical cerclage (ECC) is performed for advanced cervical dilation with exposed or prolapsed membranes and represents the most technically demanding end of the cerclage spectrum. Existing classification systems categorize cerclage by indication but do not characterize operative cervical state at presentation or separate determinants of technical feasibility from modifiers of procedural complexity. The objective was to develop standardized perioperative terminology for describing operative cervical state in ECC and to propose a feasibility–complexity framework based on bulging extent, membrane reducibility, and cervical rim adequacy.
Material and Methods: This conceptual framework development study was informed by contemporary ECC literature and tertiary obstetric surgical practice. Operative descriptors recurrently described in ECC studies were synthesized into a structured model comprising three components: bulging extent (B), reducibility of prolapsed membranes (R), and cervical rim adequacy (C). Reducibility and cervical rim adequacy were defined as primary determinants of technical feasibility, whereas bulging extent was designated as a modifier of procedural complexity once feasibility is established. The framework supports structured perioperative assessment at presentation and immediately before or during the procedure.
Results: Integration of the B–R–C components provides standardized perioperative descriptors and defines three feasibility‐based operative categories: low‐complexity, high‐complexity, and technically non‐feasible ECC. The framework explicitly separates technical feasibility from procedural complexity and supports consistent perioperative assessment, inter‐operator communication, and comparison across clinical settings and studies.
Conclusions: This state‐based framework aligns ECC assessment with the operative cervical state encountered at presentation and around the time of surgery, rather than indication alone. By distinguishing indication‐based eligibility, technical feasibility, and procedural complexity, it provides standardized perioperative terminology that may improve interpretation of existing evidence, support structured feasibility assessment, and inform future validation studies in ECC.
Related
- Contemporary Use of Common Procedural Terminology (CPT) Codes for Surgical Management of Cerebellopontine Angle Tumors
- Short-Term Safety of Gastric Endoscopic Submucosal Dissection in Patients Aged 80 Years or Older Under a Standardized Inpatient Post-Procedural Surveillance Pathway: Data from a 13-Year Real-World Cohort Study
- Quantifying procedural burden during stent-assisted coil embolization for unruptured intracranial aneurysms: development of the aneurysm endovascular procedural complexity score and internal validation of a multivariable complication model
- Feasibility and Procedural Considerations of Balloon‐Expandable TAVR in Patients With Prior Endovascular Aortic Stent Grafts
- Prognostic value of chronic total occlusion complexity scoring systems beyond procedural planning: a comparative analysis of five contemporary scores in patients undergoing chronic total occlusion percutaneous coronary intervention
BibTeX
@article{park2026standardized,
title = {{Standardized perioperative terminology for emergency cervical cerclage: A framework for feasibility and procedural complexity assessment}},
author = {Yong‐Jin Park and Moon‐Il Park},
journal = {Acta Obstetricia et Gynecologica Scandinavica},
year = {2026},
month = jul,
doi = {10.1111/aogs.70331},
url = {https://doi.org/10.1111/aogs.70331},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Standardized perioperative terminology for emergency cervical cerclage: A framework for feasibility and procedural complexity assessment
AU - Yong‐Jin Park
AU - Moon‐Il Park
PY - 2026
DA - 2026/07/29
JO - Acta Obstetricia et Gynecologica Scandinavica
DO - 10.1111/aogs.70331
UR - https://doi.org/10.1111/aogs.70331
AB - Introduction: Emergency cervical cerclage (ECC) is performed for advanced cervical dilation with exposed or prolapsed membranes and represents the most technically demanding end of the cerclage spectrum. Existing classification systems categorize cerclage by indication but do not characterize operative cervical state at presentation or separate determinants of technical feasibility from modifiers of procedural complexity. The objective was to develop standardized perioperative terminology for describing operative cervical state in ECC and to propose a feasibility–complexity framework based on bulging extent, membrane reducibility, and cervical rim adequacy. Material and Methods: This conceptual framework development study was informed by contemporary ECC literature and tertiary obstetric surgical practice. Operative descriptors recurrently described in ECC studies were synthesized into a structured model comprising three components: bulging extent (B), reducibility of prolapsed membranes (R), and cervical rim adequacy (C). Reducibility and cervical rim adequacy were defined as primary determinants of technical feasibility, whereas bulging extent was designated as a modifier of procedural complexity once feasibility is established. The framework supports structured perioperative assessment at presentation and immediately before or during the procedure. Results: Integration of the B–R–C components provides standardized perioperative descriptors and defines three feasibility‐based operative categories: low‐complexity, high‐complexity, and technically non‐feasible ECC. The framework explicitly separates technical feasibility from procedural complexity and supports consistent perioperative assessment, inter‐operator communication, and comparison across clinical settings and studies. Conclusions: This state‐based framework aligns ECC assessment with the operative cervical state encountered at presentation and around the time of surgery, rather than indication alone. By distinguishing indication‐based eligibility, technical feasibility, and procedural complexity, it provides standardized perioperative terminology that may improve interpretation of existing evidence, support structured feasibility assessment, and inform future validation studies in ECC.
SN - 0001-6349
SN - 1600-0412
ER -