Cervical Cerclage : Purpose, Procedure, Benefits and Risks

Overview

Cervical cerclage is a procedure that closes the cervix of a pregnant woman to prevent premature birth. It is performed due to a weakened cervix. It helps the fetus stay safely inside the womb without possible complications until birth.

This blog gives a comprehensive understanding of cervical cerclage, its purpose, the procedure, its benefits, and risks.

What is cervical cerclage?

When a pregnant woman’s cervix is weak, the chances of miscarriage or premature delivery are high. In such situations, the doctor may recommend performing cervical cerclage. It is an outpatient procedure that closes the cervix with stitches to allow the baby to continue to thrive until delivery. It can be done in a hospital or a surgical centre, and women are most like discharged on the same day .

Why is cervical cerclage performed?

There are various reasons for the doctor to suggest cervical cerclage during pregnancy. Some of the reasons for cervical cerclage include the following: 

• Weakened (incompetent) cervix can happen because of past surgeries such as LEEP (Loop electrosurgical excision procedure) or other surgeries on the cervical tissue
• Past miscarriages due to abnormally shaped or damaged cervix
• Past miscarriages during the second trimester that indicate a weakened cervix

Pregnant women must discuss past pregnancies, miscarriages, and procedures with their doctor. If the doctor believes that the woman may benefit from a cervical cerclage procedure, they will perform it about 12 to 14 weeks into the pregnancy, before the cervix thins out.

How is the procedure performed?

Before the procedure 

The doctor discusses the patient’s medical history and past complications from pregnancies or surgeries. The procedure also requires the doctor to check for infection and abnormalities in the cervix – through scans, swabs, and samples of amniotic fluids.

If the patient has an infection, doctors may also prescribe antibiotics .

During the procedure

During the cervical cerclage procedure:

1. You will lie back on an examination table with your legs open and both the feet in the stirrups the same way when you undergo a vaginal exam.
2. Some pain-numbing medication like a local anesthetic will be given to you, so you will not feel any discomfort/pain during the procedure. However, you may feel a small pinch when a needle is inserted into your cervix to numb it.

3. After administering the anesthesia, your healthcare provider will stitch your cervix closed with strong sutures, tightening it until it’s secure.

The surgery is performed in two ways – trans vaginal or trans abdominal.

The surgery is either performed through the vagina (trans vaginal) or the belly (trans abdominal):

• Trans Vaginal: It is the most common way to perform the procedure. The doctor uses a tool known as a speculum to hold the vagina open to reach and stitch the cervix.
• Trans Abdominal: When the cervical stitch in the past wasn’t helpful, or the cervix is short, the doctor may recommend surgery. A trans abdominal cerclage is a small but very strong, synthetic woven band stitched high on the cervix. The band will support the full length of cervix and fights the growing pressure of the fetus. The band prevents the cervix from opening and losing the pregnancy.

After the procedure

After surgery, the doctor monitors the patient for any complications. If no complications occur, the patient may get discharged on the same day. Antibiotics prevent any cervical infection. 

As an aftercare instruction, doctors recommend the following

• Complete rest on the day of the procedure
• Avoid strenuous exercise or sexual intercourse for ten days, till the stitches heal

It is important to follow the above recommendations and continue follow-up appointments to monitor their pregnancy.

When to seek medical advice?

Women must call the doctor immediately if they experience any of the following:

• A high fever (over 100 degrees Fahrenheit)
• Excessive bleeding
• Vaginal odour or discharge that smells bad
• Water breaking or leaking
• Contractions or pain in the lower abdomen at regular intervals

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What are the benefits of cervical cerclage?

The procedure prevents preterm labour, and delivery before 37 weeks for women with a weakened cervix.

What are the risks of undergoing a cervical cerclage procedure? 

As with any surgery, this procedure may cause problems that may include:

• Infection
• Bleeding
• Damage to the cervix
• Preterm labour
• Cervix or uterus tearing if labour progresses while sutures are still intact
• Cervical stenosis (permanent narrowing of the cervix)
• Scar tissue on the cervix
• Premature rupture of membranes – the water breaks prematurely, triggering preterm labour. The baby rests inside a woman’s uterus in amniotic fluid, also known as the ‘bag of water’ or ‘membranes.’

Conclusion

It is natural for women to feel scared or have questions if they are required to undergo a cervical cerclage procedure. This procedure has a success rate of nearly 90% in all of the cases. Women diagnosed with short or incompetent cervix during pregnancy can suffer from the condition in subsequent pregnancies. Women must speak without hesitation with the doctor about how to plan for a healthy pregnancy, ask them any questions they have, and get their concerns addressed.

Frequently Asked Questions (FAQs) 

Is a cervical cerclage procedure painful? 

For a few days after the procedure, it is normal for women to experience cramping and minor bleeding or spotting. After a cervical cerclage procedure, women must not feel more pain than they would during a menstrual period. To relieve any cramping or discomfort, they may be prescribed medications . Women must contact the doctor immediately if they have intense abdominal cramping or pain.

Is it acceptable for women to have sex before and after a cervical cerclage procedure?

The doctor may ask women to abstain from sexual activity for a week before the cervical cerclage procedure and probably for a week to 10 days after the procedure is complete to let the cervical stitches heal.