Brief Description – Cervical cerclage is a procedure in which stitches are used to close the lower part of the womb (cervix) during pregnancy to help prevent pregnancy loss or premature birth.
Why the Test is Performed
Before pregnancy, the cervix is closed and rigid. During pregnancy, the cervix gradually softens, decreases in length (effaces) and opens (dilates) in preparation for birth. If you have an incompetent or weak cervix, however, your cervix might begin to open too soon. As a result, you could experience pregnancy loss or give birth prematurely. But not every woman with this problem qualifies to have cerclage. Discuss with your doctor to know if you can have a cerclage or not.
How the Test is Performed
Most cervical cerclage procedures are done through the vagina. It can also be done through the abdomen if you have an extremely short, lacerated or scarred cervix or the vaginal route is unsuccessful.
During trans-vaginal cervical cerclage, your doctor will insert a speculum into your vagina and grasp your cervix with ring forceps, ultrasound guidance may be required. Your doctor will likely use the McDonald cerclage or the Shirodkar cerclage.
To place the McDonald cerclage, your doctor will use a needle to put stitches around the outside of your cervix. Next, he or she will tie the ends of the sutures to close your cervix.
In the Shirodkar method, your doctor will use ring forceps to pull your cervix toward him or her while pulling back the side walls of your vagina. Next, he or she will make small incisions in your cervix where it meets your vaginal tissue. Then, he or she will pass a needle with tape through the incisions and tie your cervix closed. Your doctor might use stitches to reposition vaginal tissue affected by the incisions.
During trans-abdominal cervical cerclage, your doctor will make an abdominal incision. He or she might elevate your uterus to gain better access to your cervix. Next, your doctor will use a needle to place tape around the narrow passage connecting the lower part of your uterus to your cervix and tie your cervix closed. Then he or she will set your uterus back into place and close the incision. The procedure also can be done laparoscopically.
How to Prepare For the Test
Before cervical cerclage, your doctor will check your baby’s vital signs and rule out any major birth defects. Your doctor might take a swab of your cervical secretions or do amniocentesis — a procedure in which a sample of amniotic fluid is removed from the uterus — to check for
infection. If you have an infection that requires antibiotics, you will complete treatment before the cerclage is done — if possible.
During the Test
You will feel discomfort and pain before the anaesthesia kicks in. Try not to look at what your doctor is doing to avoid psychologic pain.
After the Test
After cervical cerclage, your doctor will do an ultrasound to check your baby’s well-being. You might experience some spotting, cramps and painful urination for a few days. Paracetamol is recommended for pain or discomfort. If your doctor used stitches to reposition vaginal tissue affected by incisions in your cervix, you might notice passage of the material in two to three weeks as the stitches dissolve.
If you had cervical cerclage because your cervix had already begun to open or an ultrasound showed that your cervix is short, you might need to remain in the hospital for observation. As a precaution, your doctor might recommend limiting physical activity and sex until up to week 34 of pregnancy.
Your doctor might recommend weekly or biweekly visits to examine your cervix until it is time to remove the cerclage so you can give birth.
Risks associated with cervical cerclage include:
- Vaginal bleeding
- A tear in the cervix (cervical laceration)
- Prolapse of the foetal membranes into the vagina
- Preterm premature rupture of the membranes — when the fluid-filled membrane that surrounds and cushions the baby during pregnancy (amniotic sac) leaks or breaks before week 37 of pregnancy
- Preterm labour and premature birth
Discuss with your doctor immediately if you notice any problems after doing the procedure.