When a cervix is weak (sometimes called "incompetent cervix") there is a greater likelihood for a premature birth because the cervix will shorten or open too early. To prevent premature labor, the doctors may recommend a cervical cerclage to inhibit these early changes, and thus prevent premature labor.
What is cervical cerclage?
During the surgical procedure called cervical cerclage, the cervix is sewn closed.
Why is cervical cerclage used?
A weak cervix may be the result of:
· History of second-trimester miscarriages
· A previous "cone biopsy" or a "LEEP" procedure, or
· 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 later in pregnancy. Known as an emergent cerclage, this surgical procedure may become necessary after opening or shortening of the cervix have already begun. If an emergent cerclage is ever required, future pregnancies will probably also require a cervical cerclage.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.Are there 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.Does 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 will be performed by a doctor who specializes in high risk pregnancies,
· Your doctor will discuss pain control options for the procedure, and
· 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. The doctor will stitch a band of strong thread around the cervix, and the thread then 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 activities, and
· 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 can be removed when the water breaks or contractions start. Most stitches are removed in the doctor’s office without problems. The removal 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 is very minimal, and most health professionals feel a cerclage as a life saving procedure outweighs the possible risks involved.
Possible risks 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, and
· Risks associated with general anesthesia including 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, and· Your water breaking or leaking.
What about future pregnancies?
Most women who have a cerclage in one pregnancy will need to have a cerclage placed in future pregnancies.