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Definition

A cervical cerclage is a procedure that holds the cervix closed during pregnancy. The cervix is a narrow canal between the uterus (womb) and vagina.

The Cervix

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Reasons for Procedure

During pregnancy, the closed cervix keeps the baby inside the uterus until delivery. A cervix that opens too early can lead to pregnancy loss or premature birth. A cervical cerclage is done to keep the cervix closed and help a pregnancy reach 37 weeks. It is usually done between 12 and 14 weeks of pregnancy. It stays in place until the risk of pregnancy loss or premature birth has passed.

This procedure may be done on people who are pregnant and have:

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

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Problems from anesthesia, such as wheezing or sore throat
  • Infection of the cervix or amniotic sac that protects the baby
  • Premature labor or birth
  • Preterm premature rupture of membranes (PPROM)
  • Inability of the cervix to dilate during normal labor—cervical dystocia
  • Trauma to the cervix or nearby structures

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Stopping sexual activity one week before the procedure
  • Arranging a ride to and from surgery
  • Tests that will need to be done before surgery, such as a transvaginal ultrasound

Anesthesia

The doctor may give:

  • Regional anesthesia —you will be numb from the belly down
  • General anesthesia—you will be asleep

Description of Procedure

This procedure may be done two ways:

Vaginal Surgery

A tool called a speculum will be used to hold the vagina open. This will allow the doctor to view the cervix. One of the following will then be done:

  • Stitches will be put around the outside of the cervix and tightened and tied to close it. It can later 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 it. The band will be pulled to close the cervix. If this is a temporary cerclage, it may be removed at a surgery center with anesthesia.

Abdominal Surgery

An incision will be made in the abdomen to access the cervix. A band will be placed around the outside of the cervix. The band will be pulled 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 by cesarean section.

How Long Will It Take?

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

Will It Hurt?

Discomfort and cramping are common after surgery. Medicine can help.

Average Hospital Stay

Most people are able to leave the same day. Some may need to stay overnight. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Care Center

Right after the procedure, the staff will monitor you for signs of premature labor.

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

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

There are also steps you can take to lower your risk of infection, such as:

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

At Home

Activities will be limited for at least a week. This will include sex. You may need to ask for help with daily activities and delay your return to work.

Call Your Doctor

Call the doctor if you are not getting better or you have:

  • Signs of infection, such as fever or chills
  • Unexpected or excessive vaginal bleeding, discharge, or pain
  • Cramping or contractions
  • Water that leaks or breaks
  • New or worsening symptoms

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

RESOURCES:

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

American Pregnancy Organization
http://americanpregnancy.org

CANADIAN RESOURCES:

Society of Obstetricians and Gynecologists of Canada
http://sogc.org

Women’s Health Matters
http://www.womenshealthmatters.ca

REFERENCES:

Cervical cerclage. American Pregnancy Association website. Available at: http://americanpregnancy.org/pregnancy-complications/cervical-cerclage. Accessed August 17, 2021.

Cervical cerclage. Encyclopedia of Surgery website. Available at: http://www.surgeryencyclopedia.com/Ce-Fi/Cervical-Cerclage.html. Accessed August 17, 2021.

Prevention of preterm labor and preterm birth. EBSCO DynaMed website. Available at: https://www.dynamed.com/prevention/prevention-of-preterm-labor-and-preterm-birth. Accessed August 17, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board James Cornell, MD  Last Updated: 8/17/2021