What is Cervical Cerclage?

When is Cervical Cerclage suggested?

 

Before pregnancy, the cervix is closed, and it maintains a long and firm shape. The cervix relaxes, shrinks in length, and dilates during pregnancy as it prepares for birth. When the patient’s cervix opens too soon during your pregnancy, the patient may be at risk of miscarriages or preterm delivery due to the cervix being weak and incompetent.

If you have any of the following conditions, your doctor may propose cervical cerclage during pregnancy to prevent premature birth:

• A history of pregnancy loss in the second trimester due to non-painful cervical dilatation in the absence of labour or placental abruption (history-indicated cervical cerclage)

   

• Due to painless cervical dilatation in the second trimester, a prior cerclage was performed.

   

• During the second trimester, a painless cervical dilatation is discovered.

   

• In a singleton pregnancy, a short cervical length (less than 25 millimetres) before 24 weeks of pregnancy

   

 

Who is not eligible for this procedure?

Cervical cerclage isn't suitable for patients who are at risk of developing complications mentioned earlier. If the following conditions are present, your doctor may not propose a cervical cerclage:

• Active vaginal bleeding

   

• Active preterm labor

   

• An intrauterine infection

   

• Premature rupture of membranes — when the amniotic sac leaks or breaks before week 37 of pregnancy

   

• Twin or higher order pregnancy

   

• A fetal anomaly incompatible with life

   

• The amniotic sac protrudes past the opening of the cervix, causing prolapsed foetal membranes.

   

How is this surgery performed?

Most cervical cerclage procedures are done through the vagina under the administration of general anesthesia at a hospital/clinic. In some cases, where the cervix is too short or scarred, the procedure is done through the abdomen.

The surgeon will introduce a speculum into your vagina and use ring forceps to grab the cervix during transvaginal cervical cerclage. The guidance could be done with ultrasound. This process is usually carried out using one of the two procedures listed below.

McDonald operation: The surgeon will sew sutures across the outside of the cervix with a needle. The sutures will then be bound together to seal your cervix.

Shirodkar operation: The surgeon will use ring forceps to pull your cervix towards him or her while pulling back the side walls of your vagina. The surgeon will then make small incisions where your cervix joins your vaginal tissue. The surgeon will next seal your cervix with a needle and tape through the incisions. Finally, the stitches are used to reposition the vaginal tissue affected by the incisions.

During transabdominal cervical cerclage, the surgeon will make an abdominal incision. To have better access to the cervix, the surgeon will raise the uterus. Following that, the health care practitioner will wrap tape across the thin passage linking the bottom part of the uterus to the cervix and tie the cervix shut with a needle. Then he or she will reposition your uterus and close the wound.

What are the risks involved in the procedure?

Like any surgical procedure, some risks exist. These may include:

• Infection

   

• Bleeding

   

• Premature contractions

   

• Rupture of membranes (water breaking)

   

• If the stitch fails, it could result in a miscarriage or a premature birth.

   

What do I need to know about post-procedure care for cervical cerclage?

For a few days, the patient may have spotting, cramps, and difficult urination. To alleviate the pain, the surgeon will prescribe an oral medicine.

The patient will also be advised to be at ease and rest for 3-4 days post procedure, and advised not to lift heavy weights until the stitches heal and settle.

In some cases of cerclage procedure, patients are advised not to indulge in sexual intercourse until further follow-ups with their doctor. The cerclage will be removed at the 37th week of your pregnancy.