Understanding Cervical Cerclage: Categories, Methods, Safety Measures, and Potential Complications

Contents

• Introduction

• What Is Cervical Cerclage?

• Why Cervical Cerclage Is Performed

• How the Procedure Works

• Risks and Complications

• When to Remove the Cerclage

• When to Contact Your Doctor

• Conclusion

• Frequently Asked Questions (FAQs)

Introduction

For expectant mothers at risk of premature delivery, medical advancements offer hope in prolonging pregnancy and supporting fetal development. One such proven intervention is cervical cerclage, a surgical technique designed to prevent early cervical opening during pregnancy. This detailed guide provides everything you need to know about the procedure—from indications and surgical steps to aftercare and possible side effects.

What Is Cervical Cerclage?

Cervical cerclage is a preventative surgical procedure aimed at reducing the risk of premature birth. It involves placing strong sutures or a synthetic band around the cervix to reinforce it and keep it closed throughout pregnancy.

There are two primary methods:

• Transvaginal Cerclage: The most common technique, performed via the vagina.

• Transabdominal Cerclage: A more complex option where the stitch is placed through the abdomen, often using open surgery or laparoscopy.

This procedure is especially beneficial for women with cervical insufficiency, a condition where the cervix opens painlessly before labor, increasing the risk of second-trimester pregnancy loss or premature birth.

Typically, cerclage is performed between 12 and 14 weeks of gestation—early enough to provide structural support during the critical growth stages of pregnancy.

Why Cervical Cerclage Is Performed

Cervical cerclage is recommended in the following scenarios:

1. History-Indicated (Prophylactic): Suggested for women who have experienced second-trimester losses due to painless cervical dilation without labor or placental complications.

2. Ultrasound-Indicated: Used when transvaginal ultrasound shows a cervical length of less than 25 mm before 24 weeks in women with a history of preterm delivery or miscarriage.

3. Physical Examination-Indicated (Emergency Cerclage): Done when the cervix is already dilating without contractions or infection, typically before 24 weeks.

Other contributing factors include a history of cervical surgeries (e.g., LEEP procedures) or uterine abnormalities. In these cases, cerclage may help support the pregnancy and reduce miscarriage risk.

How the Procedure Works

Pre-Procedure Preparation

Before scheduling cerclage, your obstetrician will conduct a thorough review of your medical history, including a pelvic exam and imaging (usually a transvaginal ultrasound) to assess cervical condition.

During the Procedure

The procedure is usually performed in a hospital setting under general or regional anesthesia:

• The patient is positioned similarly to a standard gynecological exam.

• The cervix is visualized, and durable sutures are placed to close the cervical opening.

• The process typically takes less than an hour.

Post-Procedure Recovery

After surgery, patients are observed for several hours. Mild cramps and light vaginal bleeding are normal and typically subside within a few days.

Recommended aftercare includes:

• Using sanitary pads (avoid tampons)

• Staying hydrated and urinating regularly

• Lying on the left side for rest

• Avoiding physical exertion for several days

• Abstaining from intercourse for at least two week

Risks and Complications

While generally safe, cervical cerclage may present the following risks:

• Infection (including chorioamnionitis)

• Premature rupture of membranes (PROM)

• Cervical damage or scarring

• Bleeding or spotting

• Uterine contractions or early labor

• Cervical stenosis (narrowing of the cervix)

• Tearing if labor starts before stitch removal

Your doctor will assess the benefits versus risks based on your condition.

When Should the Cerclage Be Removed?

Removal is usually planned between 36 and 37 weeks of pregnancy, once the fetus is mature and the risk of early labor is minimal.

Early removal may be necessary if:

• Labor begins prematurely

• Membranes rupture

• Vaginal bleeding occurs

• Infection (chorioamnionitis) is suspected

• Emergency delivery is required

For patients with a transabdominal cerclage, the stitch remains in place during a cesarean and may be kept for future pregnancies.

When to Contact Your Doctor

After cerclage placement, you should seek immediate medical attention if you experience:

• A fever over 100.5°F (37.8°C)

• Regular contractions or lower abdominal pain

• Heavy vaginal bleeding

• Leaking fluid or signs of your water breaking

• Foul-smelling vaginal discharge

• Persistent vomiting or nausea

Prompt response to these symptoms is crucial for both maternal and fetal health.

Conclusion

Cervical cerclage plays a critical role in helping women with a weak or shortened cervix carry their pregnancies to term. While not without risks, its success rate in preventing preterm labor is high—especially when guided by careful monitoring and timely intervention. Understanding the purpose, process, and precautions of cervical cerclage empowers women to make informed decisions and stay proactive about their pregnancy care.

Frequently Asked Questions (FAQs)

1. Is the cervical cerclage procedure painful?
The procedure itself is not painful due to anesthesia. Some discomfort such as mild cramping or spotting may occur afterward.

2. What are the benefits of cervical cerclage?
It significantly reduces the risk of preterm birth in women with cervical insufficiency, with a success rate of up to 90%.

3. What should I avoid after cerclage placement?
Avoid heavy lifting, strenuous exercise, sexual intercourse, long travel, and substances like alcohol or tobacco without medical clearance.

4. At what stage of pregnancy is cerclage performed?
Usually between 12 and 14 weeks, although emergency procedures can occur up to 24 weeks depending on individual risk factors.

5. How is cervical insufficiency diagnosed?
Doctors use transvaginal ultrasounds between 16 and 24 weeks of pregnancy to measure cervical length and check for early dilation.

6. How much rest is needed after the procedure?
Rest for 2–3 days post-surgery is common. Most women can resume light daily activities within 1–2 weeks if approved by their doctor.

7. Is vaginal birth possible after cerclage?
Yes, if the stitch is removed at 36–37 weeks, vaginal delivery is often possible. Transabdominal cerclage, however, requires cesarean delivery.

 

                    Dr.Ifrah Hassan Hilaac