Cervical cerclage

When a woman's cervix is weak (sometimes called cervical incompetence), she is more likely to have a premature baby because the cervix shortens or opens too early. To prevent preterm labor, a woman's doctor may recommend a cervical cerclage. Cerclage is used to prevent these early changes in a woman's cervix, thereby preventing preterm labor. A closed cervix helps the developing baby stay in the womb until the mother reaches 37–38 weeks of pregnancy.

What is a cervical cerclage?

Cervical leakage treatment is a surgical procedure called cervical cerclage, in which the cervix is sutured during pregnancy. The cervix is the lowest part of the uterus and extends into the vagina.

Why is cervical cerclage used?

A cervical cerclage procedure may be used if a woman's cervix is at risk of dilating under the pressure of a growing pregnancy.

A weak cervix can be the result of:

History of second-trimester miscarriages
A previous “cone biopsy”
Damaged cervix by abortion

When is a cervical cerclage used?

The best time for a cervical cerclage procedure is the third month (12-14 weeks) of pregnancy. However, some women may need cerclage later in pregnancy; this is known as an emergency cerclage and is needed after changes such as opening or shortening of the cervix have already begun.

If urgent cerclage is needed, future pregnancies will likely also require cervical cerclage.

What are the alternatives to the cervical cerclage procedure?

If changes in the cervix occur very late in pregnancy, or if the cervix has already dilated significantly, bed rest may be a better alternative.

What are the benefits of cervical cerclage?

A cervical cerclage helps prevent miscarriages or premature births caused by a leaking cervix. The operation is successful in 85-90% of cases. Cervical banding is effective in the presence of true cervical insufficiency, but unfortunately, the diagnosis of cervical insufficiency is very difficult and may be inaccurate.

Why don't all women who give birth to premature babies need a cerclage?

Cerclage can only help women with an abnormal or "incompetent" cervix. However, even with tying, other problems can cause labor to start prematurely. Women who have cerclage need to be checked regularly for other complications such as infections and preterm labor.

What should I expect before my cervical cerclage is placed?

Your medical history will be reviewed
A thorough exam of your cervix including a transvaginal ultrasound performed by a doctor who specializes in high-risk pregnancies
Your doctor will discuss pain control options for the procedure
Write down any questions or concerns you may want to discuss with your doctor

What happens during a cervical cerclage procedure?

Most women use general, spinal, or epidural anesthesia to control pain during the procedure. The doctor will sew a strong strip of thread around the cervix, and the thread will be taut to keep the cervix tightly closed.

What can I expect after the procedure?

You can stay in the hospital for a few hours or overnight to monitor for preterm labor or labor.
Immediately after the procedure, you may experience light bleeding and slight cramping, which should stop after a few days. This may be followed by an increase in thick vaginal discharge, which may continue until the end of the pregnancy.
You may be given medicine to prevent infection or preterm labor.
For 2-3 days after the procedure, plan to rest at home; avoid unnecessary physical activity.
Your doctor will discuss with you when to resume your normal activities.
It is often recommended to abstain from sexual intercourse for a week before and at least a week after the procedure.

How long is the cerclage stitch left in?

Typically, the thread is removed at 37 weeks of pregnancy, but it can be removed earlier if the water breaks or contractions begin. Most sutures are removed in the doctor's office without any problems. The procedure is similar to a Pap smear and may cause light bleeding.

What are the risks of having a cerclage placed?

The likelihood of any risks occurring is very minimal, and most medical professionals believe that cerclage is a life-saving procedure that outweighs the potential risks involved.

Possible risks may include:

Premature contractions
Cervical dystocia (inability of the cervix to dilate normally in the course of labor)
Rupture of membranes
Cervical infection
Cervical laceration if labor happens before the cerclage is removed
Some risks associated with general anesthesia include vomiting and nausea