What is the Shirodkar technique for cervical cerclage?

The Shirodkar procedure, developed by Dr. V. N. Shirodkar in 1955, is a more permanent transabdominal cervical cerclage technique performed under general anaesthesia.

Procedure

1. Foley's catheter is inserted before surgery to empty the urinary bladder.

2. The abdomen is opened by a midline incision.

3. The round ligaments are located from the internal inguinal ring up to the uterus and are dissected free of the peritoneum.

4. The cervical canal is encircled with a purse-string suture with the round ligaments included.

5. After repositioning the uterus into the abdomen, the abdominal incision is closed.

6. The vaginal wall is incised, the cervix is exposed, and the purse string suture is tied snugly around the cervix but not tight enough to obstruct the cervical canal.

7. The vaginal incision is sutured closed.

The Shirodkar procedure is often preferred when there has been a history of multiple failed vaginal cerclages or extreme cervical weakness requiring a very tight cerclage. It has the lowest rate of iatrogenic preterm delivery and the highest cervical competence rate of all three techniques but, also, has the highest rate of complications.