What is Cervical Cerclage?
Cervical cerclage is a surgical procedure in which the cervix is stitched close to prevent premature birth or abortion during pregnancy.
The cervical cerclage procedure is useful in patients who have an incompetent or weak cervix. The weak cervix could be a result of either a previous diagnostic procedure like Loop Electrosurgical Excision Procedure (LEEP) or cone biopsy, previous history of late miscarriages or damage caused during abortion.
Now, the cervix is part of the uterus that opens up into the vagina. In a normal pregnancy, the cervix is initially closed and rigid. As the pregnancy progresses, the fetus keeps growing and this keeps producing pressure on the cervix. Initially the cervix is rigid, but gradually it begins to shorten in length and open up to for the coming birth. In women who have a weak cervix, there is great probability that the cervix will shorten and open up too early during the pregnancy. This could lead to either premature labor or miscarriage. Premature birth has been associated with serious health conditions such as respiratory illness, inability of maintain body temperatures and other infections. Hence, cervical cerclage will benefit such patients by helping them carry their babies to full-term.
What are the Types Of Cervical Cerclage?
There are mainly three types of cervical cerclage: transvaginal cerclage (TVC), transabdominal cerclage (TAC), transvaginal cervico-isthmic cerclage (TVCIC). TVC is preferred option for patients striving for normal delivery as the stitches are removed at week 37 when the pregnancy reaches full-term or when the water breaks and contractions begin, whichever occurs earlier. TAC is the more permanent option where the stiches are not removed and the patient needs a C-section. TVCIC gives the flexibility of both the vaginal delivery and a C-section, depending on the patient’s medical condition.
When is Cervical Cerclage Done?
Typically, this procedure is done in the third month of pregnancy (Weeks 12 to 14). It is recommended to be done before the cervix starts to shorten or open up. However, this procedure can also be done late in the pregnancy once changes in the cervix have started to occur. This will be called an emergent cerclage.
What are the Risks or Complications Associated With Cervical Cerclage?
As this is a surgical procedure, there could be risks associated with general anesthesia such as nausea or vomiting. There is also a high risk of developing infections because of the stitch. Other risks include, tearing in the cervix (cervical laceration), permanent narrowing of the cervix (cervical stenosis), inability of the cervix to dilate normally during labor (cervical dystocia), prolapse of fetal membranes into the vagina, rupture/leak of the amniotic sac before week 37 of pregnancy, vaginal bleeding, preterm labor/miscarriage, and the need for cerclage for all future pregnancies.
Who Should Avoid Cervical Cerclage?
This procedure is only helpful to prevent premature birth in cases of a true weak cervix.
Women who have multiple pregnancies, have already dilated more than 4 cm, have a intrauterine infection, have ruptured or prolapsed fetal membranes, or those having vaginal bleeding should be discouraged from having this procedure.
What are the Alternatives To Cervical Cerclage?
Some women may want to opt for a non-surgical way to prevent/delay pre-term labor. Such patients may want to consider complete bed rest for the duration of the pregnancy. This should reduce the strain on the cervix. In addition, the healthcare provider may suggest using medications to stop or slow down labor. These could include some antibiotics, drugs like ritrodrine, terbutaline or magnesium sulfate. Patients may also consider using vaginal progesterone prophylactically, as it is also known to help in prevention of preterm labor.
The healthcare provider needs to be very careful in judging the benefits of the procedure versus the risks. However, in cases of the true weak cervix, when performed early in the pregnancy, this procedure has been lifesaving with a success rate of 85 to 90%.
- American College of Obstetricians and Gynecologists (ACOG): https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2018/09/cervical-insufficiency
- Mayo Clinic: https://www.mayoclinic.org/tests-procedures/cervical-cerclage/about/pac-20384615
- Cleveland Clinic: https://my.clevelandclinic.org/health/treatments/10062-cervical-cerclage
- NHS (National Health Service): https://www.nhs.uk/conditions/cervical-cerclage/
- American Pregnancy Association: https://americanpregnancy.org/pregnancy-complications/cervical-cerclage/
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