Informed consent for cervical cerclage placement to prevent preterm birth due to cervical insufficiency, covering procedure types, risks, and removal plan.
The Cervical Cerclage Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, obgyn, cerclage, cervical insufficiency, preterm birth, maternal fetal medicine. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Cervical Cerclage Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ **Gestational Age at Placement:** ___________ **Ordering Provider:** ___________ **Planned Procedure Date:** ___________ --- ## 1. Procedure I, the undersigned patient, consent to cervical cerclage placement performed by my healthcare provider. **Cerclage type:** ___________ **Planned approach:** ___________ **Planned anesthesia:** ___________ Cervical cerclage is a procedure in which suture material is placed around the cervix to reinforce it and help prevent premature dilation and preterm birth in patients with cervical insufficiency or a history of second-trimester pregnancy loss. **McDonald cerclage:** A purse-string suture of braided or monofilament material is placed at the cervicovaginal junction without bladder dissection. The suture ends are tied anteriorly and left with tails for later removal. **Shirodkar cerclage:** The vaginal mucosa is incised anteriorly and posteriorly to place the suture higher on the cervix, closer to the internal os, then buried under the mucosa. **Transabdominal cerclage (TAC):** Placed via laparotomy or laparoscopy at the cervico-isthmic junction, typically reserved for failed transvaginal cerclage or anatomically unsuitable cervix. Delivery must be by cesarean section; the TAC can be left in place for future pregnancies. The planned cerclage removal date (if transvaginal) is typically **36–37 weeks of gestation** unless preterm labor, rupture of membranes, or another obstetric indication requires earlier removal. ---