What is cervical cerclage?
Cervical cerclage is a surgical procedure some women need during pregnancy. The cervix is temporarily stitched closed to prevent pregnancy loss or premature birth. The cervix is the outlet from a woman's uterus. During pregnancy, it stretches and gets thinner (effaces) and opens up (dilates) to allow her baby to travel through the birth canal (vagina).
Why is cervical cerclage performed?
Your health care provider might recommend cervical cerclage if your cervix begins to open too soon in your pregnancy without signs or symptoms of contractions or labor. This condition is called "cervical insufficiency." It is somewhat rare, but likely to result in miscarriage or preterm birth. Cervical cerclage also may be needed if:
- History indicates: In the past, you had a second-trimester pregnancy loss and/or preterm birth or a delivery with cervical insufficiency. Rarely, cervical cerclage may be needed due to prior cervical injury (e.g., cervical cancer or other procedure-related injuries).
- Ultrasound indicates: You are pregnant with only one fetus, have a history of prior preterm birth and a short cervical length (<25mm) as determined by ultrasound during 16-23 weeks of gestation.
- Physical exam indicates: You are diagnosed with cervical insufficiency at 16 to 23 weeks of pregnancy.
What are the risks of cervical cerclage?
Cervical cerclage is typically done between 12-24 weeks of pregnancy. Risks include:
- A tear in the cervix (laceration)
- Dropping of the fetal membranes into the vagina (prolapse)
- Rupture of the amniotic sac
- Preterm labor or premature birth
What happens during a cervical cerclage?
Cervical cerclage is typically done at a hospital or surgery center on an outpatient basis under regional or general anesthesia.
It can be done through the abdomen, but more frequently is done through the vagina. A speculum is inserted in the vagina so the doctor can grasp your cervix with forceps. He or she will use a needle to place a stitch around the outside of your cervix. The ends of the thread are then tied together to close your cervix.
After the procedure is complete, you will have an ultrasound to check on your baby. Some women need to remain in the hospital for observation. You also may need to take antibiotics to help prevent infection or medications to keep the uterus from contracting. Some women experience spotting, cramps or painful urination for a few days after cervical cerclage. Typically, another ultrasound is performed 1 week after the procedure to check the cerclage placement. Your health care provider will need to continue to see you weekly or every-other-week until you give birth for follow-up examination of your cervix.
Before labor begins, your doctor will schedule a time to remove the stitch. If your labor starts before that time, the cerclage will be removed on an emergency basis to allow for a vaginal delivery. In rare circumstances, the baby may need to be delivered by cesarean section instead.