The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic cerclage for prevention of recurrent pregnancy loss due to cervical incompetence.

The guidance was considered for reassessment in October 2010 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.


Recurrent late miscarriages may be due to a weak (sometimes called an incompetent) cervix that shortens or opens too early in pregnancy. Cervical cerclage involves placing a stitch around the upper part of the cervix to keep it closed; the operation may be carried out through the vagina, or through the abdomen, as an open or laparoscopic ('keyhole') procedure.

Coding recommendations

In pregnant woman

R12.1 Cerclage of cervix of gravid uterus

Y75.2 Laparoscopic approach to abdominal cavity NEC

Codes in category Y95.- Gestational age must be assigned in a subsidiary position where this information is available.

Or in non-pregnant woman

Q05.1 Repair of cervix uteri NEC

Includes: Cerclage of cervix of non-gravid uterus

Y75.2 Laparoscopic approach to abdominal cavity NEC

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.