What Is Cervical Cerclage?
Cervical cerclage is a surgical procedure performed to reduce the risk of miscarriage or preterm birth in women diagnosed with cervical insufficiency (incompetent cervix). During pregnancy, the cervix normally remains closed to protect the fetus. However, in cases of cervical insufficiency, the cervix may not be strong enough and may begin to open prematurely. Cervical cerclage involves surgically stitching the cervix to help keep it closed until delivery.
Cervical cerclage is generally performed in the following situations:
Indications for Cervical Cerclage
Cervical Insufficiency: A history of painless cervical dilation and pregnancy loss during the second trimester (13–24 weeks).
Short Cervix: A cervical length of less than 25 mm measured by transvaginal ultrasound, which increases the risk of miscarriage or preterm birth.
Cervical Abnormalities: Congenital cervical anomalies or weakening of the cervix due to previous cervical surgeries (such as LEEP or conization).
Previous Pregnancy Losses: Recurrent second-trimester pregnancy losses.
Types of Cervical Cerclage
Cervical cerclage is classified into different types based on the method of application:
Transvaginal Cerclage
McDonald Cerclage: The most commonly used technique. Sutures are placed around the cervix via the vaginal route, usually between 12–14 weeks of pregnancy.
Shirodkar Cerclage: Similar to the McDonald method, but the suture is placed higher on the cervix using a more complex technique. It is preferred in cases where the cervix is very short or structurally compromised.
Transabdominal Cerclage
This method is used when transvaginal cerclage is not feasible or has previously failed. The suture is placed at the upper portion of the cervix through an abdominal approach. This technique is more invasive and is typically performed via laparotomy (open surgery) or laparoscopy (minimally invasive surgery).
Emergency Cerclage
Emergency cerclage is performed when cervical dilation has already begun but the fetal membranes are still intact. This procedure is usually carried out as an urgent intervention during the second trimester.
How Is Cervical Cerclage Performed?
The procedure is usually performed in a hospital setting under general or spinal anesthesia. The main steps include:
Preparation: The patient is taken to the operating room and anesthesia is administered. The patient is placed in the gynecological position.
Access to the Cervix: For transvaginal cerclage, a speculum is inserted into the vagina to visualize the cervix. For transabdominal cerclage, a small incision is made in the abdomen.
Placement of Sutures: One or two sutures are placed around the cervix using synthetic material (such as Mersilene tape) to keep it closed.
Final Check: After suturing, the area is cleaned and bleeding is controlled. The procedure typically takes 30–60 minutes.
Recovery and Observation: The patient is observed for a short period after the procedure and may be discharged on the same day if no complications occur.
Recovery After Cervical Cerclage
Recovery is usually uncomplicated, but patients should be aware of the following:
Rest: Rest is recommended for a few days after the procedure. Heavy lifting, strenuous activity, and sexual intercourse should be avoided.
Vaginal Discharge and Mild Bleeding: Light spotting or discharge is normal. However, heavy bleeding, foul-smelling discharge, or severe cramping should be reported to a physician immediately.
Suture Removal: In transvaginal cerclage, sutures are typically removed at around 37 weeks of gestation. In transabdominal cerclage, sutures are usually removed during cesarean delivery.
Follow-Up Appointments: Regular prenatal visits and ultrasound monitoring are essential to assess cervical integrity and pregnancy progression.
Risks and Complications of Cervical Cerclage
As with any surgical procedure, cervical cerclage carries some risks:
Infection: Signs include fever, severe vaginal discharge, and lower abdominal pain.
Cervical Injury: Sutures may cause damage to the cervix, potentially affecting future pregnancies.
Premature Rupture of Membranes: Early rupture of the amniotic sac may occur, though it is rare.
Bleeding: Bleeding may occur during or after the procedure and may require urgent intervention in severe cases.
Advantages of Cervical Cerclage
Reduced Risk of Preterm Birth: Cervical cerclage significantly lowers the risk of early delivery due to cervical insufficiency.
High Success Rate: When performed in appropriately selected patients, it helps pregnancies progress to later gestational stages.
Prevention of Pregnancy Loss: Particularly effective in preventing recurrent second-trimester pregnancy losses.
Cervical cerclage is an important treatment option for women diagnosed with cervical insufficiency. By surgically reinforcing the cervix, it helps reduce the risk of miscarriage and preterm birth, contributing to a safer pregnancy. However, due to potential risks, a thorough evaluation is essential, and the decision should be made jointly by the patient and the physician.