In cases of cervical incompetence, the Shirodkar procedure is occasionally
necessary when the McDonald procedure cannot be used due to poor cervical a
natomic conditions. We have further facilitated a modified Shirodkar proced
ure with some modifications. A transverse incision over the anterior lip of
the cervix is made and the bladder is separated from the cervix. One end o
f an atraumatic forceps is introduced deeply into the space between the bla
dder and the cervix, and the other end is pushed against the posterior forn
ix to grasp paracervical tissues, so that a needle is easily passed through
at the tip of the forceps. The knot is placed anteriorly and a silk thread
is passed around the tape in the posterior fornix to facilitate removal of
the tape. This procedure resulted in no complications and greatly facilita
ted removal of the tape, resulting in a cervical cerclage which was compara
tively easily carried out.