Cervical cerclage is a method used to help pregnant people with a shortened or an insufficient cervix to prolong their pregnancies. It is a stitch or synthetic tape placed around the cervix to help it remain closed. First performed in 1902 and used fairly commonly since the ‘60s, cerclage isn’t right for all pregnant people with cervical issues, but in the right situations, it can be an important part of maintaining a healthy pregnancy.
When a doctor might offer cerclage
There are several reasons that people may need a cerclage. Most cerclages are recommended for people who have had cerclage in a past pregnancy, or have experienced a prior second trimester loss from cervical insufficiency and painless dilation. This is placed early in the late first or early second trimester. Another reason that someone may need a one, called a “rescue” cerclage, is when a certain degree of cervical shortening or dilation is detected, especially in those with a prior history of preterm birth before 24 weeks gestation.
Since cerclage does carry its own risks with it, doctors do not recommend it unless they have determined that the risks of not acting outweigh the risks involved in the procedure. Risks include infection, premature rupture of membranes, vaginal bleeding and abruption.
Who is cerclage not right for?
Cerclage is generally not recommended for people who are carrying multiples. Cerclage is also not recommended for those who are at risk for preterm labor or birth for reasons other than cervical insufficiency, or short cervix. It is also not recommended for people who are in preterm labor, are showing evidence of an infection, signs of abruption, or whose water has broken.
What does the procedure look like?
Most people undergoing cerclage placement have it performed while under regional anesthesia – that is, spinal anesthesia. Cerclage is generally placed through a vaginal approach, but very uncommonly in certain cases it may be performed through the abdomen. The physician places a stitch around the cervix in a purse-string fashion and then the stitch is tied down tightly.
Cerclage is generally put in in the third month of pregnancy, between weeks 12 and 14, but if the cervix starts to open later, cerclage can be put in then.
What happens after cerclage is put in?
After a cervical cerclage procedure, the patient may be asked to stay in the hospital for a few hours or overnight for observation. During this time, they may experience light bleeding and cramping, and may notice a thicker vaginal discharge that may continue throughout the pregnancy. After returning home, they may be recommended to avoid strenuous activity for a few days, and may need to abstain from sexual intercourse for 7-10 days after the procedure. Around the time cerclage is put in, many people start taking vaginal progesterone, as another way of treating a shortened cervix.
Cerclage is generally removed around 36 weeks of pregnancy, after which the baby is generally agreed to have developed enough to be born healthy. The stitches can be taken out early if t contractions start before that time. When the stitches are taken out, there may be some light bleeding. Stitches can sometimes be taken out during a normal doctor’s visit, but sometimes need to be taken out in an operating room under anesthesia.
People who have had a cervical cerclage put in and notice any of the following signs should contact their doctors immediately, since these may be signs of complications with the procedure:
- Contractions or intense cramping
- Back pain that moves in waves like labor pain
- Vaginal bleeding
- Fever, vomiting, or nausea
- Strong-smelling vaginal discharge
- Water breaking or leaking
- Abdominal tenderness or pain
Cervical cerclage isn’t right for all, but in cases where it is called for, it can be very successful.
Reviewed by the Ovia Health Clinical Team
Sources
- “Cervical cerclage.” MayoClinic. The Mayo Clinic, March 17 2015. Web.
- “Cervical cerclage.” RCOG. Royal College of Obstetricians and Gynaecologists. May 2011. Web
