How Is a Cervical Cerclage Performed?

The procedure is usually done under anesthesia (spinal or general) and during the second trimester of pregnancy

Cervical cerclage is a procedure used to stitch up the mouth of the uterus during pregnancy to prevent miscarriage or premature birth. The procedure is usually done under anesthesia (spinal or general) and during the second trimester of pregnancy (12-20 weeks).

• During a cervical cerclage, an instrument known as a speculum is lubricated and inserted into the vagina.
• The speculum is gently opened when inside. This helps to spread the walls of the vagina and allow access to the cervix.
• A needle will then be used to place stitches around the outside of the cervix and the ends of the sutures will be tied to close the cervix.
• The procedure usually takes less than 90 minutes.
• Hospital stay depends on the type of stitch used and the history of events in the pregnancy so far. Usually, the patient may need to stay in the hospital for 1-2 days after the surgery if it is done as an emergency. Sometimes, patients may go home the same day if the cerclage is done electively, about 12-14 weeks of the pregnancy.
• This cervical stitch is usually removed at 36-37 weeks of pregnancy unless the patient goes into labor before the expected date.

Usually, the procedure is done through the vagina. In a few cases, it may be done through the abdomen. The abdominal approach is an uncommon procedure but may be recommended if a vaginal cervical stitch has not worked in the past or if it is not possible to insert a vaginal stitch. The abdominal approach is usually considered during early pregnancy. It may be done through a cut on the abdomen or via keyhole surgery. This sort of stitch is not removed, and the baby would need to be born by cesarean section.

Why is a cervical cerclage done?

The cervix is the lower part of the uterus that opens to the vagina. During pregnancy, the rigid cervix helps to keep the fetus inside the uterus. As the pregnancy progresses, the cervix softens in preparation for birth. If the cervix does not stay closed until the baby is full-term, a miscarriage or premature birth may occur. The cervical cerclage may help to keep the cervix closed until the baby is considered full-term. Women with a weak or incompetent cervix are candidates for cervical cerclage. This condition may cause the cervix to dilate painlessly without contractions before the baby is full-term, typically between 16-24 weeks of pregnancy. Causes of a weak cervix may include the following:

• Women with a history of premature delivery (18-22-week delivery)
• Women with a short cervix, seen on an ultrasound
• Women with prior surgery or damage to the cervix
• Daughters of women who took DES, a hormone used to prevent miscarriage

What are the risks involved in cervical cerclage?

The risks involved in cervical cerclage include:

• Anesthesia risks (headache, vomiting, dizziness)
• Bleeding
• Infection
• Injury to the bladder
• Injury to the cervix
• Amniotic sac rupture (water breaking in pregnant women)
• Injury to cervix and scarring
• Inflammation of fetal membranes causing bacterial infection of the uterus and amniotic fluid
• It sometimes is not possible to put the stitch in, for example, if your cervix is already too short or too far open. The stitch may not always work, and you might still experience a late miscarriage or preterm birth. A cervical stitch does not increase your chances of needing induction of labor or a cesarean section.

If menopause occurs in a woman younger than ___ years, it is considered to be premature.
See Answer

What care should I take after cervical cerclage?

The patient may return to normal activities within a few days of the procedure and may need to have regular visits with your doctor.

• The first few days after surgery, the patient may need to rest most of the day.
• Generally, the patient may return to work within a few days if the cerclage was electively done. If it was performed as an emergency procedure, the patient may need to be out of work for an extended period.
• All sexual activity and breast stimulation should be stopped if the cerclage was performed under emergency conditions.
• The patient may visit the doctor every 1-3 weeks and the cervix may be checked more frequently. Ultrasounds will tell the doctor if your cervix is getting shorter but may not be able to tell if your cervix is dilating. It is important not to miss an appointment. Patients should call their doctor if they experience below cramping, contractions, or tightening
• Pressure in the lower back, abdomen, or backache
• Excessive vaginal bleeding or discharge
• Foul-smelling vaginal discharge
• Water break

If an abdominal cerclage is done, the patient may need another operation to remove the stitches put. The removal of stitches is done during the subsequent cesarean section.