When a woman’s cervix is weak (sometimes called an incompetent cervix) she is more likely to have a baby born prematurely because the cervix shortens or opens too early. In order to prevent premature labor, a woman’s doctor may recommend a cervical cerclage. A cerclage is used to prevent these early changes in a woman’s cervix, thus preventing premature labor. A closed cervix helps a developing baby stay inside the uterus until the mother reaches 37-38 weeks of pregnancy.
What is cervical cerclage?
Treatment for cervical incompetence is a surgical procedure called cervical cerclage, in which the cervix is sewn closed during pregnancy. The cervix is the lowest part of the uterus and extends into the vagina.
Why is cervical cerclage used?
A cervical cerclage procedure may be used if a woman’s cervix is at risk of opening under the pressure of the growing pregnancy. A weak cervix may be the result of:
- History of second-trimester miscarriages
- A previous “cone biospy” or a “LEEP” procedure
- Damaged cervix by pregnancy termination
When is a cervical cerclage used?
The best time for the cervical cerclage procedure is in the third month (12-14 weeks) of pregnancy. However, some women may need a cerclage placed later in pregnancy; this is known as an emergent cerclage and is necessary after changes such as opening or shortening of the cervix have already begun. If an emergent cerclage is required, future pregnancies will probably also require a cervical cerclage.
What are alternatives to the cervical cerclage procedure?
If changes in the cervix are found very late in pregnancy, or if the cervix has already opened up significantly, bed rest may be the best alternative.
What are the benefits of a cerclage?
Cervical cerclage helps prevent miscarriage or premature labor caused by cervical incompetence. The procedure is successful in 85% to 90% of cases. Cervical cerclage appears to be effective when true cervical incompetence exists, but unfortunately the diagnosis of cervical incompetence is very difficult and can be inaccurate.
Why doesn’t every woman who has had a preterm baby need a cerclage?
Only women with an abnormal or “incompetent” cervix can be helped by a cerclage. However, even with the help of a cerclage, other problems can cause labor to begin too early. Women who have a cerclage placed will need to be checked routinely for other complications such as infection and preterm labor.
What should I expect before my cervical cerclage is placed?
- Your medical history will be reviewed
- A thorough exam of your cervix including a transvaginal ultrasound performed by a doctor who specializes in high risk pregnancies
- Your doctor will discuss pain control options for the procedure
- Write down any questions or concerns you may want to discuss with your health care provider
What happens during the cervical cerclage procedure?
Most women have general, spinal, or epidural anesthesia for pain control during the procedure. A doctor will stitch a band of strong thread around the cervix, and the thread will be tightened to hold the cervix firmly closed.
What can I expect after the procedure?
- You may stay in the hospital for a few hours or overnight to be monitored for premature contractions or labor.
- Immediately after the procedure you may experience light bleeding and mild cramping, which should stop after a few days. This may be followed by an increased thick vaginal discharge, which may continue for the remainder of the pregnancy.
- You may receive medication to prevent infection or preterm labor.
- For 2-3 days after the procedure, plan to relax at home; avoid any unnecessary physical activity.
- Your doctor will discuss with you when would be the appropriate time to resume regular activites.
- Abstinence from sexual intercourse is often recommended for one week before and at least one week after the procedure.
How long is the cerclage stitch left in?
Generally the thread is removed at the 37th week of pregnancy, but it can be removed before if a woman’s water breaks or contractions start. Most stitches are removed in the doctor’s office without any problems. The procedure is similar to having a pap smear and may cause some light bleeding.
What are the risks of having a cerclage placed?
The likelihood of risks occurring is very minimal, and most health professionals feel a cerclage is a life saving procedure that outweighs the possible risks involved. Possible risks could include:
- Premature contractions
- Cervical dystocia (inability of the cervix to dilate normally in the course of labor)
- Rupture of membranes
- Cervical infection
- Cervical laceration if labor happens before the cerclage is removed
- Some risks associated with general anesthesia include vomiting and nausea
Are there signs I should look for after the cerclage is placed that indicate a problem?
It is important to contact your doctor if you experience any of the following symptoms after your cerclage is placed:
- Contractions or cramping
- Lower abdominal or back pain that comes and goes like labor pain
- Vaginal bleeding
- A fever over 100 F or 37.8 C, or chills
- Nausea and vomiting
- Foul-smelling vaginal discharge
- Your water breaking or leaking
What about future pregnancies?
Most women who need a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.
Compiled using information from the following sources:
William?s Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 9.
Danforth?s Obstetrics and Gynecology Ninth Ed. Scott, James R., et al, Ch. 4.
American Pregnancy Association, http://www.americanpregnancy.org