{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T23:36:38Z","timestamp":1791070598029,"version":"4.1.0"},"reference-count":16,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"abstract":"Abstract<\/jats:title>\n \n Introduction<\/jats:title>\n Emergency cervical cerclage (ECC) is performed for advanced cervical dilation with exposed or prolapsed membranes and represents the most technically demanding end of the cerclage spectrum. Existing classification systems categorize cerclage by indication but do not characterize operative cervical state at presentation or separate determinants of technical feasibility from modifiers of procedural complexity. The objective was to develop standardized perioperative terminology for describing operative cervical state in ECC and to propose a feasibility\u2013complexity framework based on bulging extent, membrane reducibility, and cervical rim adequacy.<\/jats:p>\n <\/jats:sec>\n \n Material and Methods<\/jats:title>\n This conceptual framework development study was informed by contemporary ECC literature and tertiary obstetric surgical practice. Operative descriptors recurrently described in ECC studies were synthesized into a structured model comprising three components: bulging extent (B), reducibility of prolapsed membranes (R), and cervical rim adequacy (C). Reducibility and cervical rim adequacy were defined as primary determinants of technical feasibility, whereas bulging extent was designated as a modifier of procedural complexity once feasibility is established. The framework supports structured perioperative assessment at presentation and immediately before or during the procedure.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Integration of the B\u2013R\u2013C components provides standardized perioperative descriptors and defines three feasibility\u2010based operative categories: low\u2010complexity, high\u2010complexity, and technically non\u2010feasible ECC. The framework explicitly separates technical feasibility from procedural complexity and supports consistent perioperative assessment, inter\u2010operator communication, and comparison across clinical settings and studies.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This state\u2010based framework aligns ECC assessment with the operative cervical state encountered at presentation and around the time of surgery, rather than indication alone. By distinguishing indication\u2010based eligibility, technical feasibility, and procedural complexity, it provides standardized perioperative terminology that may improve interpretation of existing evidence, support structured feasibility assessment, and inform future validation studies in ECC.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/aogs.70331","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:21:22Z","timestamp":1785313282000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Standardized perioperative terminology for emergency cervical cerclage: A framework for feasibility and procedural complexity assessment"],"prefix":"10.1111","author":[{"given":"Yong\u2010Jin","family":"Park","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cervical Insufficiency Center Dongtan Jeil Women's Hospital Hwaseong Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0890-0259","authenticated-orcid":false,"given":"Moon\u2010Il","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Cervical Insufficiency Center Dongtan Jeil Women's Hospital Hwaseong Republic of Korea"},{"name":"Department of Obstetrics and Gynecology Hanyang University Hospital Seoul Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Green\u2010Top Guideline No.75: Cervical Cerclage","author":"Royal College of Obstetricians and Gynaecologists 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