What is McDonald Cerclage?
McDonald cerclage is a surgical procedure used in
obstetrics to treat cervical incompetence, a condition where the cervix shortens and opens prematurely during pregnancy, leading to a risk of preterm birth or miscarriage. This procedure involves placing a stitch around the cervix to reinforce it and is usually performed during the second trimester.
Why is McDonald Cerclage Performed?
The main indication for a McDonald cerclage is
cervical incompetence. Women who have a history of second-trimester pregnancy losses or preterm births due to cervical insufficiency are candidates for this procedure. It is typically recommended when there is evidence of cervical shortening or dilation in a current pregnancy.
How is McDonald Cerclage Performed?
The procedure is generally carried out under regional anesthesia, such as
spinal anesthesia, or occasionally under general anesthesia. The surgeon uses a strong suture material to place a stitch around the cervix, usually in a purse-string fashion. This stitch provides support to the cervix, helping to keep it closed during pregnancy.
What are the Risks and Complications?
Like any surgical procedure, McDonald cerclage carries certain risks, although they are relatively rare. Potential complications include
infection, bleeding, rupture of membranes, and preterm labor. In some cases, the stitch may need to be removed if complications arise. Close monitoring by healthcare providers is essential to manage these risks effectively.
When is the Stitch Removed?
The timing of stitch removal varies, but it is commonly removed around the 37th week of pregnancy or earlier if labor begins. The removal is typically performed in a clinical setting and does not require anesthesia. In cases of emergency, such as the onset of preterm labor or rupture of membranes, the stitch may be removed sooner.What are the Success Rates?
McDonald cerclage has a high success rate in preventing preterm births in women with a history of cervical incompetence. Studies indicate that the procedure can significantly reduce the risk of preterm delivery and extend the duration of pregnancy to a safer gestational age, allowing for better
fetal development and outcomes.
Who Should Avoid McDonald Cerclage?
Not all women are suitable candidates for McDonald cerclage. It is generally not recommended for women with active labor, infection, bleeding, or ruptured membranes. Additionally, those with multiple gestations may not benefit from the procedure due to the increased pressure on the cervix. A thorough evaluation by a healthcare provider is essential to determine eligibility.Are There Alternatives to McDonald Cerclage?
Alternatives to McDonald cerclage include other types of cervical cerclage, such as
Shirodkar cerclage, which involves a more invasive approach to placing the stitch. Another alternative is a transabdominal cerclage, recommended for women with an extremely short cervix or previous failed vaginal cerclages. Conservative management with
progesterone therapy and bed rest may also be considered in certain cases.
Conclusion
McDonald cerclage is a valuable and effective intervention for managing cervical incompetence in pregnant women, helping to prevent preterm births and improve pregnancy outcomes. However, it requires careful patient selection and monitoring to minimize risks and ensure the best results. Women considering this procedure should engage in thorough discussions with their healthcare providers to understand the benefits, risks, and alternatives available to them.
