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Contents 9
What Is Cervical Cerclage?
Cervical cerclage is a surgical procedure performed on women diagnosed with cervical insufficiency (an incompetent cervix) to reduce the risk of preterm birth or miscarriage. The cervix normally stays closed throughout pregnancy to protect the fetus. However, in cervical insufficiency, the cervix may not be strong enough, which can cause it to open prematurely. In this situation, cervical cerclage is used to surgically stitch the cervix closed so that it remains closed until the time of delivery.
Cervical cerclage is generally performed in the following situations:
Indications for Cervical Cerclage
Cervical Insufficiency: A history of painless cervical dilation in the second trimester (13-24 weeks) in a previous pregnancy, followed by pregnancy loss.
Short Cervix: A cervical length measured by transvaginal ultrasound of less than 25 mm, which increases the risk of miscarriage or preterm birth.
Cervical Anomalies: Weakening of the cervix due to congenital cervical anomalies or previous cervical surgeries (such as LEEP or conization).
History of Pregnancy Loss: In women who have experienced recurrent pregnancy losses in the second trimester.
Types of Cervical Cerclage
Cervical cerclage is divided into different types according to how it is performed:
Transvaginal Cerclage:
McDonald Cerclage: The most commonly used method. In this procedure, a stitch is placed in the cervix through the vagina. It is usually performed between the 12th and 14th weeks of pregnancy.
Shirodkar Cerclage: Similar to the McDonald method, but the stitch is placed at a higher level using a somewhat more difficult technique. It may be preferred when the cervix is shorter or more problematic.
Transabdominal Cerclage:
This method is used when cerclage cannot be performed vaginally or when a vaginal cerclage has failed. A stitch is placed in the upper part of the cervix through an abdominal approach. This method is more invasive and is generally performed by laparotomy (open surgery) or laparoscopy (minimally invasive surgery).
Emergency Cerclage:
This is performed when cervical dilation has already begun but the fetal membranes are still intact. This type of cerclage is generally applied as an emergency intervention in the second trimester.
How Is Cervical Cerclage Performed?
Cervical cerclage is generally performed in a hospital under general or spinal anesthesia. The steps of the procedure are as follows:
Preparation: The patient is taken to the operating room and anesthesia is administered. During the procedure, the patient is positioned as for a gynecological examination.
Access to the Cervix: In vaginal cerclage, a speculum is inserted into the vagina to make the cervix visible. In transabdominal cerclage, the cervix is accessed through a small incision in the abdomen.
Placing the Stitch: Usually 1-2 stitches are placed in the cervix using a synthetic band or suture material (such as Mersilene tape). These stitches aim to keep the cervix closed and prevent it from opening prematurely.
Checking and Completion: After the stitches are placed, the surgical area is cleaned and checked for bleeding. The procedure usually takes 30-60 minutes.
Recovery and Observation: After the procedure, the patient is kept under observation for a short period. If there are no complications, the patient may be discharged the same day.
Recovery Process After Cervical Cerclage
The recovery process after cervical cerclage is generally uneventful, although complications can occur in some cases. Here is what you should know about the recovery process:
Rest: A few days of rest are recommended after the procedure. Excessive physical activity, heavy lifting, and sexual intercourse should be avoided.
Vaginal Discharge and Light Bleeding: Mild vaginal discharge or light bleeding after cerclage is normal. However, if you notice heavy bleeding, foul-smelling discharge, or severe cramping, you should see your doctor.
Removal of the Stitches: If a vaginal cerclage was performed, the stitches are usually removed at 37 weeks of pregnancy. In transabdominal cerclage, the stitches may be removed during delivery via cesarean section.
Follow-Up Appointments: The condition of the cervix is monitored through regular doctor visits and ultrasound examinations. These check-ups are important for assessing whether the cervical cerclage has been successful and whether the pregnancy is progressing safely.
Risks and Complications of Cervical Cerclage
As with any surgical procedure, cervical cerclage carries certain risks and possible complications. These include:
Infection: There is a risk of infection after cerclage. Signs of infection include fever, heavy vaginal discharge, and lower abdominal pain.
Cervical Damage: Damage to the cervix can occur due to the stitches placed in it. This damage may cause problems in future pregnancies.
Premature Rupture of Membranes (Water Breaking Early): Premature rupture of the amniotic sac after cerclage can occur, although rarely.
Bleeding: Bleeding may occur during or after the procedure. In cases of heavy bleeding, emergency intervention may be required.
Advantages of Cervical Cerclage
Reducing the Risk of Preterm Birth: Cervical cerclage can significantly reduce the risk of preterm birth caused by cervical insufficiency.
High Success Rate: When performed on suitable patients, cervical cerclage successfully allows the pregnancy to reach a more advanced stage.
Preventing Pregnancy Loss: Cervical cerclage can be effective in preventing pregnancy loss, particularly for women who have experienced recurrent losses in the second trimester.
Cervical cerclage is an important treatment option for women diagnosed with cervical insufficiency. Surgically closing the cervix helps reduce the risk of preterm birth and miscarriage, contributing to a safer pregnancy. However, as with any surgical procedure, cervical cerclage carries its own risks and complications. For this reason, a detailed evaluation should be carried out before the procedure, and the decision should be made jointly by the patient and the doctor.