Around one in 100 pregnant mothers have a weak cervix during pregnancy, which cannot hold the baby till the end of gestation (1). Experts refer to such a cervix as an incompetent cervix because it opens up early during pregnancy and increases the risk of premature birth or miscarriage. To manage this condition, a surgical procedure called the cervical cerclage is carried out, where the cervix is stitched to help it hold the baby. Your doctor will decide whether you need the procedure or not if a cervical issue is diagnosed. Read this post to understand more about cervical cerclage, the procedure, and the risks involved.
What Is Cervical Cerclage?
Cervical cerclage or cervical suture is a surgical procedure done to prevent an incompetent cervix from opening up early during pregnancy. It is done by stitching the cervix to hold it and avoid premature delivery (1). The procedure, which has been in vogue for more than 50 years, is usually done in the second trimester to hold the pregnancy until 37 weeks. The cervical suture is done only if it is necessary and the necessity is determined by certain factors.
Why Is Cervical Cerclage Done?
The suture is done in the below cases (2) (3):
Risk of miscarriage due to an abnormally shaped uterus or damaged cervix.
Previous preterm labor or pregnancy loss in the second trimester due to cervical incompetence.
Changes in the cervix that may lead to premature birth.
A previous surgery or trauma to the cervix due to destructive forces or forced dilatation.
History of inflammation or infection.
Cervical shortening.
The above factors make you more prone to premature delivery and hence the stitch might be required. However, the procedure is not done too early in your pregnancy.
What Is The Right Time For Doing Cervical Cerclage?
Cervical cerclage is usually done at 12 to 14 weeks of pregnancy, i.e., before the cervical effacement (1). In some cases, this procedure is done at 24 weeks but seldom after that due to the risk of amniotic sac rupture. Some women have to undergo emergency cerclage in the later stages if the cervix has already begun to open (2 to 4cm) (3). The procedure is carried out only if the doctor diagnoses cervical issues during medical check-ups.
What Is The Preparation Process For Cervical Cerclage?
An incompetent cervix is diagnosed by the history of pregnancy losses and through an ultrasound scan. A scan helps determine the cervical dilation and short cervix (cervical length of less than 25mm). Here is the preparation process for the procedure (4):
An ultrasound scan is done to check the health of the fetus.
A blood test checks for any infections.
The mother should avoid having food or water for eight hours before surgery to prevent nausea and vomiting during the surgical procedure (6).
The mother should avoid sexual intercourse for a week before the procedure.
Stop taking any medications.
The preparation begins once the appointment is fixed for the cerclage procedure.
What To Expect During And After The Procedure?
Cervical cerclage is carried out by giving a general, spinal, or epidural anesthesia. A special instrument called speculum is inserted into the vagina to spread the vaginal walls apart to carry out the surgery. One of the three methods is used for the cerclage (4): Laparoscopic transabdominal cerclage method is being preferred to the other types because it does not require hospitalization, has less post-operative pain and is quick to heal. If incompetence of cervix is diagnosed in the later stage then it can cause the amniotic sac to protrude through the cervix. In such cases:
A catheter is inserted into the cervix. The balloon at the end of the catheter is inflated to close the cervix.
Another method is to fill up the urinary bladder by inserting a catheter through the urethra. As the full bladder pushes the amniotic sac into the pelvis, the cervix is stitched.
After the procedure (aftercare) (5)
You will be under observation for several hours to ensure that you do not show up any sign of premature labor. The doctor will do an ultrasound scan to check the well-being of the fetus.
You might experience cramps, spotting, or vaginal discharge for a few days after the surgery.
The doctor may recommend antibiotics to fight infection and medication for pain relief.
You may be told not to engage in physical activities or sexual intercourse for a few weeks after the surgery.
In the follow-up visits, the doctor will check the stitch and look for any signs of preterm labor.
If you observe anything abnormal post-surgery, then call the doctor immediately.
When To Call The Doctor?
You need to talk to your doctor if you notice any of the following symptoms (5):
Any signs of infection along with chills or fever
Excessive vaginal discharge, bleeding, or pain
Cramping or contractions
Water break
Persistent nausea or vomiting
If any symptom gets worsened or a new symptom is noticed
You need to take proper care of yourself and avoid any physical and mental pressure for the procedure to be successful, and the sutures to be there until they are removed.
When Is Cervical Cerclage Removed?
The cerclage is usually removed at around 37 weeks or when you have preterm labor (contractions and water break) before 37 weeks of pregnancy. The mean time between the removal of the stitch and delivery is 9.4 +/- 8.8 (mean +/- standard deviation) days (6). A McDonald cerclage is removed at a hospital without any need for anesthesia while a transabdominal cerclage removal needs another incision in the abdomen.
What Is The Success Rate Of Cervical Cerclage?
The overall success rate of cervical cerclage in preventing preterm labor was found to be 80%. In case of women with cervical incompetence, the McDonald procedure increased the success rate of term deliveries to 95.4%. The rate of fetal survival after cervical cerclage was found to be 85% and premature deliveries was 18.7% (7). Although the cerclage helps decrease the chances of preterm deliveries, we cannot overlook the risks associated with it.
What Are The Risks Of Cervical Cerclage?
The risks of cervical cerclage include (4) (5) :
Infection
Excessive vaginal bleeding
Damage to the cervix during surgery
Preterm premature rupture of membranes (PPROM), when the amniotic sac breaks before 37 weeks of pregnancy
Preterm labor
Tearing of the cervix (cervical laceration), when labor progresses with the stitches in place
Permanent narrowing or closure of the cervix (cervical stenosis)
Adverse reaction to anesthesia
Another cerclage for future pregnancies
Inability of the cervix to dilate during normal labor
