Cervical cerclage
Cervical cerclage is a rarely used procedure that involves sewing shut the cervix to prevent it from opening before a pregnancy is carried near to term (week 37).
Cervical cerclage may be used if you have given birth prematurely in a previous pregnancy and had minimal or no contractions before the birth. It may also be used when the muscles of the cervix are suspected to be weakened (cervical insufficiency). If preterm labor starts, the cerclage will be removed right away. Otherwise, it is usually removed at 36 to 38 weeks of pregnancy. And labor will usually start within 2 weeks.
Why is cervical cerclage done?
Cervical cerclage may be done if you have cervical insufficiency or have a history of cervical insufficiency. This means that the cervix starts to open too early in pregnancy. You may have a history of cervical insufficiency if you:
- Had a previous pregnancy loss in the second trimester or an early delivery that occurred with few or no contractions. This is a clue that your cervix may not stay closed during pregnancy.
- Have a short cervix and have a history of early delivery.
How is cervical cerclage done?
Cervical cerclage is done using either general anesthesia or regional anesthesia (such as spinal injection). Usually cerclage is done through the vagina. A tool called a speculum is placed in the vagina. It opens the vagina a little bit. This lets your doctor see the cervix and inside the vagina. The procedure can be done in different ways:
- Stitches can be placed around the outside of the cervix.
- A special tape can be tied around the cervix and stitched in place.
- A small incision can be made in the cervix. A special tape is then tied through the cervix to close it.
If cervical insufficiency is diagnosed later in pregnancy, the amniotic sac may start to push through the cervix. This may be treated in many different ways. One way is to insert a thin tube (catheter) through the cervix, and then inflating a bulb at the end of the catheter. Another technique involves filling the bladder with liquid using a catheter inserted through the urethra. The full bladder helps to push the amniotic sac back up into the pelvis. Then the cervix can be stitched shut.
After cervical cerclage to prevent preterm delivery: When to call
Call 911 anytime you think you may need emergency care. For example, call if:
- You have severe trouble breathing.
- You have sudden, severe pain in your belly.
- You have severe vaginal bleeding.
Call your doctor now or seek immediate medical care if:
- You have new pelvic pain, or the pain in your pelvis gets worse.
- You have a new discharge from your vagina.
- You have a fever.
- You have any vaginal bleeding.
- You have a sudden release of fluid from your vagina.
- You think that you are in labor.
- You have low back pain or pelvic pressure that does not go away.
- You've been having regular contractions for an hour. This means that you've had at least 8 contractions within 1 hour or at least 4 contractions within 20 minutes, even after you change your position and drink fluids.
Watch closely for changes in your health, and be sure to contact your doctor if you have any problems.
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