Cerclage is a medical procedure wherein a band or ring is used to hold together a prematurely opening cervix during pregnancy. It’s a rarely used surgery wherein the cervix or uterus’ outlet is sewn-shut to ensure a full-term pregnancy. In other words, the cervical cerclage helps evade a preterm birth or late miscarriage. The cerclage procedure is considered successful if it leads to a full-term or close to a full-term pregnancy.
The cerclage is usually used between the 12th and 14th week prior the cervix thinning out, or post cervix thinning. Cerclage usage is not common after the 24th week as it may rupture the amniotic sac and instigate preterm birth. It is taken out at the 36th week of pregnancy or if preterm labor begins. The stitches should be taken out before labor starts. A caesarean section may be needed for delivery.
Prior to Operation
Before the surgery, an ultrasound will be conducted to check the baby’s state. An amniotic fluid sample may be taken from the uterus to confirm zero infections. If there’s an infection, antibiotics may be given and the condition treated before performing the cerclage.
Cerclage Operation and Types
Generally, the cerclage is carried out through the vagina. An instrument, called speculum, is placed inside the pregnant lady’s vagina to open up the walls and make way for the operation. If not possible, the procedure can be performed via the abdomen, called abdominal cerclage. There are two other cerclage types as well: Shirodkar cerclage and McDonald cerclage.
The cervix can be closed in any of the following ways:
- The stitches could be positioned around the cervix’s exterior.
- A unique surgical tape could envelop the cervix and then stitched in.
- A minor cut can be performed in the cervix. The tape can be then tied via the cervix for closure.
When performing cerclage, the patient is administered regional anesthesia or general anesthesia, usually in the form of a spinal injection. Typically an outpatient surgery, antibiotics and other medications could be given to the expecting mother after surgery to prevent infection and surgery pain.
After surgery, an ultrasound is performed to check on the baby’s health.
Patients normally feel cramps, painful urination and spotting for some days after the procedure. Pain-relieving drugs, such as acetaminophen, could be given to address any discomfort. Not to mention, any kind of strenuous physical activity (including sex) is prohibited until the 34th week of pregnancy. Post cerclage removal, normal activities can be resumed until natural labor sets in.
Cerclage can help extend high-risk pregnancies. For women who’ve had a premature baby due to the opened-up cervix, a cervical cerclage could mitigate another premature birth. As aforementioned, the procedure is deemed a success if labor and birth are postponed by a minimum of 37 weeks.
The risks of performing a cervical cerclage include
- Miscarriage or infection
- Cervix damage during operation
- Tremendous loss of blood
- Premature breaking of water
- Preterm labor
- Permanent cervix closure or narrowing
Cervical cerclage could be used in women who had previous premature birth(s) and had zero or little contractions prior to delivery. The stitching could also be used if the cervix muscles are incompetent or suspected to be weak.
The operation is not recommended for everyone, especially women who have abnormal vaginal bleeding, intrauterine infection, preterm labor, multiple-child pregnancy, etc. More risk scenarios may exist and vary with individuals.