Cervical Cerclage

1 What is a Cervical Cerclage?

Cervical cerclage is a procedure in which the cervix is closed up with stitches during pregnancy to prevent loss or premature birth.

The cervix is the lower part of the uterus that opens to the vagina. Cervical cerclage can be done through the vagina (transvaginal cervical cerclage). Typically, the stitches are removed around week 37 of pregnancy.

Your health care provider might recommend cervical cerclage if your cervix is at a risk of opening during pregnancy. However, cervical cerclage is not an appropriate procedure for anyone. It can lead to serious side effects and does not always prevent premature birth.

Understand the risks of cervical cerclage and whether the procedure might be beneficial to both you and your baby.

2 Reasons for Procedure

Here are the most common reasons to receive a cervical cerclage.

Before pregnancy, the cervix is closed and rigid. During pregnancy, it gradually softens, decreases in length (effaces) and opens (dilates) in preparation for birth.

If you have an incompetent or weak cervix, your cervix might begin to open too soon. As a result, you could experience pregnancy loss or give birth prematurely.

Your doctor might recommend cervical cerclage during pregnancy to prevent premature birth if you have the following:

  • A history of one or more second-trimester pregnancy losses that are related to painless cervical dilation and in the absence of labor or placental abruption (history- indicated cervical cerclage).
  • Prior cerclage due to painless cervical dilation in the second trimester. Upon physical exam, painless cervical dilation diagnosed during the second trimester.
  • A singleton pregnancy, a prior spontaneous premature birth at less than 34 weeks, and, upon ultrasound exam, a short cervical length (less than 25 millimeters) before a gestation period of 24 weeks.

Cervical cerclage is not the right procedure for anyone at the risk of premature birth.

Your doctor might discourage cervical cerclage in the following cases:

  • If you have vaginal bleeding.
  • If you have preterm labor.
  • If you have an intrauterine infection.
  • If you have multiple pregnancies.
  • If you have a fetal anomaly incompatible with life.
  • If you have preterm premature of membranes when the fluid-filled membrane surrounding and cushioning the baby during pregnancy (amniotic sac) leaks or breaks before week 37 of pregnancy.
  • If you have prolapsed fetal membranes, a condition in which the amniotic sac protrudes through the opening of the cervix.
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3 Potential Risks

The potential risks related to cervical cerclage include the following:

You must keep in mind that if you have cervical dilation in the second trimester, it is possible that you might experience these problems even if you do not have a cervical cerclage.

After receiving a cervical cerclage, make sure you contact your doctor immediately if you have leakage of fluid from your vagina, a sign of preterm premature rupture of membranes.

Your doctor might recommend removing the cervical cerclage early if you have preterm premature rupture of membranes and a uterine infection which depends on your stage of pregnancy.

4 Preparing for your Procedure

To prepare for a cervical cerclage, your health care provider will perform an ultrasound to check for your baby's vital signs and rule out any major birth defects.

Your doctor might take a swab of your cervical secretions or do amniocentesis, a procedure in which a sample of amniotic fluid is taken from the uterus to check for infection.

If you have an infection that requires antibiotics, you will complete treatment before the cerclage is done, if possible.

Ideally, a history-indicated cervical cerclage is done between the 12th and 14th week of pregnancy. However, cervical cerclage can be done up until the 24th week if the pelvic exam shows that your cervix is beginning to open.

Typically, cervical cerclage is avoided after the 24th week of pregnancy due to the risk of rupturing the amniotic sac and triggering premature birth. In some cases, cervical cerclage can be done before pregnancy.

If you have prolapsed fetal membrane and your doctor recommends cervical cerclage, he or she will treat the condition before doing the procedure.

5 What to Expect

Read on to learn more about what to expect before, during, and after your cervical cerclage procedure.

Cervical cerclage is generally done as an outpatient procedure at a hospital or surgery center. It can be performed under either regional or general anesthesia.

Most cervical cerclage procedures are done through the vagina. Cervical cerclage might do through the abdomen if transvaginal cerclage fails to yield positive results or anatomically difficult due to an extremely short, lacerated or scarred cervix.

During the procedure

During transvaginal cerclage, your doctor will insert a speculum into your vagina and grasp your cervix with ring forceps. He or she might make use of ultrasound for guidance.

Your doctor will likely use the McDonald cerclage or the Shirodkar cerclage. Research suggests no significant differences in the results of the two procedures.

To place the McDonald cerclage, your health care provider will use a needle to put stitches around the outside of your cervix. Next, he or she will tie the ends of the sutures to close your cervix.

In the Shirodkar method, your health care provider will use ring forceps to pull your cervix toward him or her while pulling back the side walls of your vagina. Next, he or she will make small incisions in your cervix where it meets your vaginal tissue. Then, he or she will pass a needle with tape through the incisions and tie your cervix closed. Your health care provider might use stitches to reposition vaginal tissue affected by the incisions.

During transabdominal cervical cerclage, your health care provider will make an abdominal incision. He or she might elevate your uterus to gain better access to your cervix. Next, your health care provider will use a needle to place tape around the narrow passage connecting the lower part of your uterus to your cervix and tie your cervix closed. Then he or she will set your uterus back into place and close the incision.

The procedure also can be done laparoscopically.

After the procedure

After cervical cerclage, your health care provider will do an ultrasound to check your baby's well-being.

You might experience some spotting, cramps, and painful urination for a few days. Acetaminophen (Tylenol, others) is recommended for pain or discomfort.

If your health care provider used stitches to reposition vaginal tissue affected by incisions in your cervix, you might notice the passage of the material in two to three weeks as the stitches dissolve.

If you had a history-indicated cervical cerclage, you'll likely be able to go home after you recover from the anesthetic. 

As a precaution, your health care provider might recommend avoiding sex for at least one week and, afterward, using condoms during sex.

If you had cervical cerclage because your cervix had already begun to open or an ultrasound showed that your cervix is short, you might need to remain in the hospital for observation.

As a precaution, your health care provider might recommend limiting physical activity and sex until up to week 34 of pregnancy.

Your health care provider might recommend weekly or biweekly visits to examine your cervix until you give birth.

Cervical cerclage removal

A transvaginal cervical cerclage is typically removed at around week 37 of pregnancy — or at the onset of preterm labor.

A McDonald cerclage can usually be removed in a health care provider's office without anesthetic, while a Shirodkar cerclage might need to be removed in a hospital or surgery center.

After having a transvaginal cervical cerclage removed, you'll typically be able to resume your usual activities as you wait for labor to begin naturally.

If you expect to have a C-section and plan to have children in the future, you might choose to leave a Shirodkar cervical cerclage in place throughout your pregnancy and after the baby is born. However, it's possible that the cerclage could affect your future fertility.

Consult your health care provider about your options.

If you had a transabdominal cervical cerclage, you'll need to have another abdominal incision to remove the cerclage. As a result, a C-section is typically recommended during week 37 through 39 of pregnancy. Your baby will be delivered through an incision made above the cerclage. During the C-section, you can choose to have the cerclage removed or leave it in place for future pregnancies.

6 Procedure Results

The result of cervical cerclage is debatable.

Research done suggests that cervical cerclage can reduce the incidence of premature birth. However, the timing of the cervical cerclage, in turn, can affect the outcome.

Emergency cervical cerclage is done in the presence of advanced cervical change and prolapsed membranes have the worst outcome.

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