What type of cerclage is indicated for a patient with a history of second trimester loss due to painless cervical dilation?

In cases of second trimester loss related to painless cervical dilation, history indicated cerclage is the most appropriate choice. This option is specifically recommended for patients who have a documented history of cervical incompetence or spontaneous preterm birth due to cervical dilation in the second trimester. The reasoning behind this is rooted in the understanding that the patient has previously experienced complications that were likely related to insufficient cervical support, thus identifying them as being at high risk for recurrence.

History indicated cerclage is performed before the onset of any cervical changes, often in the first trimester or early in the second trimester, when the risk of cervical dilation is recognized based on past obstetric history. This proactive approach helps to provide additional cervical support to potentially prevent preterm birth associated with cervical incompetence in future pregnancies.

The other types of cerclages, such as ultrasound indicated and physical exam indicated cerclages, are typically reserved for scenarios where there is an indication seen through imaging or during a gynecological examination, rather than solely based on historical context. Elective cerclage is not based on immediate risk factors and is more commonly done when there is no clear indication but a desire for prophylaxis in a patient without a strong history of cervical incompetence.