Cervical cerclage

Cervical cerclage, also known as a cervical stitch, is a surgical procedure performed on pregnant women to prevent or treat cervical insufficiency or incompetence, a condition where the cervix starts to dilate and efface before the pregnancy has reached term. Without intervention, cervical insufficiency can lead to premature birth or the loss of the fetus. This article provides a comprehensive overview of cervical cerclage, including its indications, types, procedure, risks, and post-procedure care.

Indications

Cervical cerclage is recommended for pregnant women with a history of one or more late miscarriages or preterm births that are suspected to be caused by cervical insufficiency. It is also indicated for women who, during the current pregnancy, have been diagnosed with a significantly shortened cervix through ultrasonography. The procedure is generally considered when the cervical length is less than 25mm before 24 weeks of gestation.

Types of Cervical Cerclage

There are mainly three types of cervical cerclage: 1. McDonald Cerclage: The most common type, involving a purse-string stitch placed around the cervix. 2. Shirodkar Cerclage: Similar to the McDonald, but the stitch is placed higher up on the cervix and involves more tissue, making it slightly more complex. 3. Transabdominal Cerclage: Used when the cervix is too short for a traditional cerclage or in cases where vaginal cerclages have failed. This procedure is more invasive as it requires abdominal surgery.

Procedure

The procedure is usually performed during the second trimester of pregnancy, between 12 and 14 weeks. It can be done in a hospital or outpatient surgical center under regional or general anesthesia. The specific steps of the procedure depend on the type of cerclage being performed but generally involve accessing the cervix through the vagina and placing a strong suture around it to keep it closed.

Risks and Complications

While cervical cerclage is generally safe, it carries risks and potential complications, such as: - Infection - Bleeding - Premature contractions - Rupture of membranes - Cervical laceration - Miscarriage or preterm birth despite the procedure

Post-procedure Care

After the procedure, the patient may be advised to avoid strenuous activities, sexual intercourse, and to be on partial or complete bed rest. Regular follow-up appointments are necessary to monitor the health of the pregnancy and the effectiveness of the cerclage.

Removal

The cervical stitch is usually removed around 37 weeks of gestation to prevent any problems during labor. However, if signs of labor occur before this time, the cerclage may be removed earlier to allow for a vaginal delivery.

Conclusion

Cervical cerclage is a critical procedure for women with cervical insufficiency to carry a pregnancy to term. It is essential for patients to be fully informed about the benefits, risks, and the care required post-procedure to ensure the best possible outcomes for both the mother and the fetus.