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
ó í
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.