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Cervical Cerclage

(Cervical Stitch)

Definition

A cervical cerclage is a procedure that holds the cervix closed during pregnancy. The cervix is a narrow canal that connects the lower part of the uterus to the vagina and allows the baby to exit during birth

Cerclage is usually done between 12-14 weeks of pregnancy. It will remain in place until the risk of pregnancy loss or premature birth has passed.

The Cervix

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Reasons for Procedure    TOP

During pregnancy, the closed cervix keeps the baby inside the uterus until delivery. An abnormal or insufficient cervix opens too early in the pregnancy and can lead to a pregnancy loss or premature birth. A cervical cerclage can help a pregnancy reach full term, at least 37 weeks, by keeping the cervix closed.

Cerclage may be done for women who are pregnant and have:

  • A history of early pregnancy losses
  • Changes in the cervix during pregnancy that may lead to premature birth
  • Short cervical length—most common
  • Structural abnormalities of the uterus
  • A history of surgery or trauma to the cervix
  • A history of inflammation or infection

Possible Complications     TOP

Potential problems are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Premature labor or birth
  • Preterm premature rupture of membranes (PPROM)
  • Infection of the cervix or amniotic sac that protects the baby
  • Adverse reaction to anesthesia
  • Inability of the cervix to dilate during normal labor—cervical dystocia
  • Another cerclage for future pregnancies
  • Trauma to the cervix or nearby structures

What to Expect    TOP

Prior to Procedure

The doctor will do a physical exam. This includes a manual pelvic exam to assess the cervix for abnormalities, such as flattening or opening. Tests may include:

  • Transvaginal ultrasound
  • Blood tests to look for potential infections

Before the procedure:

  • Talk to your doctor about any medications, herbs, or supplements you are taking. You may need to stop taking some medications up to a week before the procedure.
  • Arrange for a ride home.
  • Stop sexual activity 1 week before the procedure if requested by your doctor.
  • Stop foods and drinks the night before the procedure.

Anesthesia

A regional anesthesia is most commonly used. Medication is placed in the back to numb the lower part of the body.

If general anesthesia is used, you will be asleep during the procedure.

Description of Procedure     TOP

There are a few different methods that may be used depending on your specific needs. For procedures that can be done vaginally:

The doctor will use a speculum to hold the vagina open so the cervix can be easily seen and accessed. Two procedure options include:

  • Stitches will be put around the outside of the cervix then tightened and tied to close the cervix. This type of cerclage can be removed in the doctor’s office without anesthesia.
  • An incision will be made in the cervix and a special band will be placed around the outside of the cervix. The band will be pulled to close the cervix. If this is a temporary cerclage, it may need to be removed at a surgery center with anesthesia.

A third option requires an incision in the abdomen. The surgeon will use the incision to access the cervix and place a band around the cervix. The band will be tightened and tied to close the cervix. This cerclage will need to be removed with a later abdominal incision or during a planned cesarean section.

If a vaginal birth is planned, a temporary cerclage will be removed around 37 weeks of pregnancy. If the cerclage will be left in place for future pregnancies, the delivery must be done with a cesarean section.

How Long Will It Take?     TOP

It depends on the method used. Abdominal surgery will take the longest.

How Much Will It Hurt?     TOP

Anesthesia will prevent pain during surgery. There will be some discomfort and cramping after surgery. Discomfort after the procedure can be managed with recommended medications.

Post-procedure Care     TOP

At the Care Center

After the procedure, you will be taken to a recovery room where you and your baby will be monitored. Heart rate, blood pressure, or any signs of premature labor will be monitored.

You may be able to leave after a few hours, or you may need to stay overnight to observe for signs of premature labor. If you had regional anesthesia, your legs will be numb. You will have to wait until you can walk safely.

A longer hospital stay may be needed if the cerclage was done because your cervix had already begun to open.

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection, such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home

You will need to reduce your activities, including sexual activities, for at least a week. You may also need to do weekly visits to your doctor to check the status of your cervix until the cerclage is removed, you go into term labor, or a have a cesarean delivery.

Call Your Doctor     TOP

Call your doctor if any of these occur:

  • Signs of infection, including fever or chills
  • Unexpected or excessive vaginal bleeding, discharge, or pain
  • Cramping or contractions
  • Your water leaks or breaks
  • Persistent nausea or vomiting
  • New or worsening symptoms

If you have an emergency, call for emergency medical services right away.

RESOURCES:

American Pregnancy Organization
http://americanpregnancy.org
The American Congress of Obstetricians and Gynecologists
http://www.acog.org

CANADIAN RESOURCES:

Society of Obstetricians and Gynecologists of Canada
http://sogc.org
Women’s Health Matters
http://www.womenshealthmatters.ca

References:

Alfirevic Z, Stampalija T, et al. Cervical stitch (cerclage) for preventing preterm birth in singleton pregnancy. Cochrane Database Syst Rev. 2012;4:CD008991.
Cervical cerclage. American Pregnancy Association website. Available at:
...(Click grey area to select URL)
Updated July 2016. Accessed November 28, 2017.
Cervical cerclage. Encyclopedia of Surgery website. Available at:
...(Click grey area to select URL)
Accessed November 28, 2017.
Michels TC, Tiu AY. Second trimester pregnancy loss. Am Fam Physician. 2007;76(9):1341-1346.
Prevention of preterm labor and preterm birth. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated February 20, 2017. Accessed November 28, 2017.
Last reviewed November 28, 2017 by EBSCO Medical Review Board James Cornell, MD

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