<prompt> Which of the following investigations are essential before cervical cerclage is performed?Estimate C-reactive protein levelsPerform a white cell countPerform a transvaginal ultrasound scan to assess the cervical length and exclude funnellingPerform an ultrasound scan for fetal abnormalities and screen for aneuploidy  <response>: Ans. is d, i.e. Perform an ultrasound scan for fetal abnormalities and screen for aneuploidy Before answering the question lets discuss a few details on cervical cerclage surgery.Nomenclature for cerclage applicationOld 1999New 2007Prophylactic, electiveHistory indicatedTherapeutic, salvageUltrasound indicatedRescue, emergency urgentPhysical examination indicatedRecommendations for history indicated cerclageShould be offered to women with 3 or more previous preterm births andor second trimester lossesShould not be routinely offered to women with two or fewer previous preterm birth andor second trimester losses Level B evidenceRecommendations for USG indicated cerclageWomen with history of 1 or more spontaneous preterm births ormid trimester losses with Y, V or U detected on USG or cervical length 25mm before 24 weeks-Not recommended for women without a history of spontaneous preterm delivery or second trimester losses with incidentally detected cervical length 25mm-Not recommended for funneling of cervix in the absence of cervical shortening to 25mm A cervical cerclage should be carried out in her as she has HO 3 previous preterm deliveries.An ultrasound scan for fetal abnormalities and screening for aneuploidy should be carried out, before insertion of a history- indicated suture, to ensure both viability and the absence of lethalmajor fetal abnormalities. Assessment of cervical length is not indicated before applying a history indicated cerclage. It is not essential to perform a white cell count or C-reactive protein levels before performing a cervical cerclage. 