Saving Babies, Strengthening Care: Cervical Cerclage to Optimize Pregnancy Outcomes in Indian Women with PCOS

Dr. Sadhna Sharma

Saving Babies, Strengthening Care: Cervical Cerclage to Optimize Pregnancy Outcomes in Indian Women with PCOS

Author(s)	Dr. Sadhna Sharma
Country	India
Abstract	Background & context. Polycystic ovary syndrome (PCOS) is common among Indian women and is associated with higher risks of miscarriage, gestational diabetes, hypertensive disorders, and preterm birth. India bears the world’s largest burden of preterm births, making prevention strategies a public health priority. (PMC, BioMed Central, The Lancet) Objective. To synthesize global and India-specific evidence on optimizing pregnancy outcomes in women with PCOS, with a focus on when, for whom, and how cervical cerclage (history-, ultrasound-, or exam-indicated; transvaginal vs transabdominal) should be integrated into Indian antenatal pathways. (PubMed) Methods (scoping review). We searched medical databases and gray literature (2020–2025) for peer-reviewed studies, professional guidelines, government documents, credible podcasts/YouTube explainers, and relevant press/industry reports. Inclusion prioritized India-centric data or globally authoritative sources; exclusion removed pre-2000 primary studies unless historically pivotal (e.g., Shirodkar’s work). (missionmrcog.com) Key findings. 1. PCOS elevates obstetric risk: meta-analyses show increased odds of preterm birth; hyperandrogenic phenotypes and ART/twin gestations further amplify risk. (PMC, MDPI) 2. Cerclage is effective in defined subgroups: strongest evidence supports cerclage when a woman with prior spontaneous preterm birth or late miscarriage has a short cervix ≤25 mm in the mid-trimester; universal cerclage or use in twins without dilation is not recommended. (missionmrcog.com, NICE) 3. India-specific gaps: variable ultrasound access, sociocultural barriers to transvaginal scanning, uneven ANC quality, and regional PCOS heterogeneity (e.g., high prevalence in Kashmir) complicate equitable implementation. (Nature, Pew Research Center, PubMed) 4. Integrated care works: combining risk-based cervical-length surveillance, progesterone (where indicated), judicious cerclage, and GDM screening within national programs (PMSMA/LaQshya) is feasible and impactful; 17-OHPC is no longer advised, while vaginal progesterone remains appropriate for selected patients. (PMSMA, BioMed Central, acog.org) Conclusions & recommendations. India should embed targeted cervical-length screening (16–24 weeks) for at-risk women with PCOS, ensure referral to preterm-prevention clinics, and standardize cerclage pathways aligned with RCOG/SMFM/NICE guidance—adapted to Indian realities (urban-rural, linguistic, and resource diversity). (missionmrcog.com, publications.smfm.org, NICE)
Keywords	PCOS; preterm birth; cervical cerclage; cervical length; India; antenatal care.
Field	Medical / Pharmacy
Published In	Volume 8, Issue 5, September-October 2026
Published On	2026-10-12

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Saving Babies, Strengthening Care: Cervical Cerclage to Optimize Pregnancy Outcomes in Indian Women with PCOS

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