Cervical cerclage is a method used to help women with a shortened or an insufficient cervix to prolong pregnancy. It is a stitch 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 women 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 two different types of cerclage. The first type is called a prophylactic cerclage and that is generally recommended for women with a history of three or more first trimester miscarriages, women who have had cerclage in a past pregnancy, or women who have experienced a prior second trimester loss from cervical insufficiency and painless dilation. This type is placed early in the late first or early second trimester. The second type of cerclage is a “rescue” cerclage and is generally offered to women when a certain degree of cervical shortening or dilation is detected, especially in a woman with a prior history of preterm birth, before 24 weeks gestation.
Cerclage helps to keep the cervix from dilating, and helps to prevent cervical insufficiency, which helps to hold off early labor. Doctors might suggest cerclage based on woman’s preterm birth or second-trimester pregnancy loss from an insufficient cervix, especially if the cervix appears to be concerning for a certain degree of shortness as detected on a transvaginal ultrasound or if the cervix appears to be dilating early from no specific cause. If a cervix dilates as a result of labor, infection, or abruption, cerclage is not the appropriate treatment.
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, abruption, preterm labor, and preterm birth.
Who is cerclage not right for?
Cerclage is generally not recommended for women who are carrying multiples, since it has been linked to possible preterm labor. Cerclage is also not recommended for women who are at risk for preterm labor or birth for reasons other than cervical insufficiency, or short cervix. It is also not recommended for women 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 women who undergo 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. Her 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, she may experience light bleeding and cramping, and may notice a thicker vaginal discharge that may continue throughout her pregnancy. After returning home, she may be recommended to avoid strenuous activity for a few days, and may need to abstain from sexual intercourse for as much as a week after the procedure. Around the time cerclage is put in, many women 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 the woman’s 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.
Women 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 pregnant women, but in cases where it is called for, it can be very successful.
- “Cervical cerclage.” MayoClinic. The Mayo Clinic, March 17 2015. Web.
- “Cervical cerclage.” RCOG. Royal College of Obstetricians and Gynaecologists. May 2011. Web