Cervical cerclage is a surgical procedure used to prevent premature birth or late miscarriage in women with a short or weak cervix. The cervix is the lower part of the uterus that opens into the vagina. In some cases, it may start to dilate (open) too early during pregnancy, which can lead to complications. Cerclage involves placing stitches in the cervix to keep it closed and support the pregnancy.
A cervical cerclage is typically recommended for women who have a history of second-trimester miscarriages or premature births due to
cervical insufficiency. It may also be advised for women who are diagnosed with a short cervix during a routine ultrasound scan in pregnancy. The decision to perform this procedure is usually based on a combination of medical history, physical examination, and ultrasound findings.
Types of Cervical Cerclage
There are three main types of cervical cerclage:
Transvaginal cerclage: The most common type, performed through the vagina.
Transabdominal cerclage: Done through an incision in the abdomen, typically used when transvaginal cerclage has failed or is not possible.
Emergency cerclage: Performed when the cervix has already started to dilate in the second trimester.
Procedure Details
The procedure is usually done under regional or general anesthesia and takes about 30 minutes to an hour. During a
transvaginal cerclage, the cervix is stitched closed using strong sutures. Post-procedure, patients are often monitored for a few hours to ensure there are no immediate complications. Most women are able to go home the same day.
Risks and Complications
As with any surgical procedure, cervical cerclage carries certain risks. These can include infection, bleeding, and rupture of the membranes. Rarely, the cerclage can cause preterm labor. Close monitoring is required throughout the pregnancy to manage any potential complications.
Post-Procedure Care
After a cerclage, it's important to follow your healthcare provider's instructions closely. This typically includes avoiding heavy lifting and strenuous activities. Regular follow-up appointments will be necessary to monitor the cervix and ensure the pregnancy is progressing well. The stitches are usually removed around the 37th week of pregnancy or earlier if labor begins.
Success Rates
The success rate of cervical cerclage can vary depending on the underlying cause of cervical insufficiency and the timing of the procedure. On average, it has a success rate of about 80-90% in preventing preterm birth when performed for the appropriate indications.
Conclusion
Cervical cerclage can be a crucial intervention for women at risk of preterm birth due to cervical insufficiency. It is essential to have a thorough discussion with a healthcare provider to understand the benefits and risks associated with the procedure. With proper care and monitoring, many women who undergo cerclage can carry their pregnancies to term.
