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

The American College of

Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS

Traducido por: Dr. Pedro A. Vargas Torres Obstetra Ginecólogo

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

NOTA: Esta es una traducción libre realizada con la intención de poner al alcance de todos los que

utilizamos el español como lengua materna, la información publicada por el ACOG via internet de forma

gratuita, con el fin último de universalizar el conocimiento y en ningún momento constituye un documento

oficial.

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

The American College of

Obstetricians and Gynecologists

WOMEN’S HEALTH CARE PHYSICIANS

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

Cuadro 1. Indicaciones para el Cerclaje Cervical

en Mujeres Con Embarazos Únicos ^

Historia • 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 Ecográficos Con una Historia de Parto

Prematuro Previo • Actualmente con embarazo único, con nacimiento

prematuro espontaneo previo con menos de 34 semanas de

gestación, y con la longitud del cuello uterino corto (menos

de 25 mm) antes de las 24 semanas de gestación.

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

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

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

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

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

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

The MEDLINE database, the Cochrane Library, and the

American College of Obstetricians and Gynecologists’

own internal resources and documents were used to

conduct a literature search to locate relevant articles

published between January 2000–June 2013. The

search was restricted to articles published in the

English language. Priority was given to articles

reporting results of original research, although review

articles and commentaries also were consulted.

Abstracts of research presented at symposia and

scientific conferences were not considered adequate

for inclusion in this document. Guidelines published by

organizations or institutions such as the Nation al

Institutes of Health and the American College of

Obstetricians and Gynecologists were reviewed, and

addition al studies were located by review ing

bibliographies of identified articles. When reliable

research was not available, expert opinions from obste

trician–gynecologists were used. Studies were

reviewed and evaluated for quality according to the

method outlined by the U.S. Preventive Services Task

Force:

I Evidence obtained from at least one properly de

signed randomized controlled trial.

II-1 Evidence obtained from well-designed controlled

trials without randomization.

II-2 Evidence obtained from well-designed cohort or

case–control analytic studies, prefer a bly from more

than one center or research group.

II-3 Evidence obtained from multiple time series with

or with out the intervention. Dramatic results in un

controlled ex periments also could be regarded as this

type of evidence.

III Opinions of respected authorities, based on clinical

experience, descriptive studies, or reports of expert

committees.

Based on the highest level of evidence found in the

data, recommendations are provided and graded

according to the following categories:

Level A—Recommendations are based on good and

consistent scientific evidence.

Level B—Recommendations are based on limited or

inconsistent scientific evidence.

Level C—Recommendations are based primarily on

consensus and expert opinion.