What is Transvaginal Cerclage?
Transvaginal cerclage is a surgical procedure used to treat cervical insufficiency, a condition where the cervix begins to dilate and efface prematurely, potentially leading to preterm birth or miscarriage. The procedure involves placing a stitch around the cervix to keep it closed during pregnancy, thus providing additional support.
When is Transvaginal Cerclage Indicated?
Transvaginal cerclage is typically indicated for women who have a history of second-trimester miscarriages or preterm births due to cervical insufficiency. It is also considered for women who have a short cervix diagnosed through ultrasound in the current pregnancy. Other indications might include a previous transvaginal cerclage in a prior pregnancy that resulted in a successful term delivery.
How is the Procedure Performed?
The procedure is usually performed under regional or general anesthesia. The patient is placed in a lithotomy position, and the cervix is visualized using a speculum. A strong suture material is then placed around the cervix, often in a purse-string fashion, to tighten and close it. The procedure typically takes about 30 minutes to an hour and is usually performed between 12 and 14 weeks of pregnancy.
What are the Risks and Complications?
Like any surgical procedure, transvaginal cerclage carries some risks. These include infection, bleeding, rupture of membranes, and preterm labor. There is also a risk of cervical damage or trauma. However, the benefits often outweigh the risks for women with significant cervical insufficiency.
Post-Procedure Care and Monitoring
After the procedure, patients are usually advised to rest for a few days and avoid strenuous activities. Follow-up visits are essential to monitor the cervix and ensure the suture is intact. Ultrasound may be used to check cervical length and fetal well-being. Patients should report any signs of labor, such as contractions or vaginal bleeding, to their healthcare provider immediately.Who Should Not Have a Transvaginal Cerclage?
Transvaginal cerclage is not recommended for women with active infection, preterm labor, or ruptured membranes. It is also contraindicated in cases of multiple gestations (twins, triplets, etc.) where the risk of complications may outweigh the benefits. Each case should be evaluated individually to determine the appropriateness of the procedure.
Alternatives to Transvaginal Cerclage
For women who are not candidates for transvaginal cerclage, other options include vaginal progesterone therapy and cervical pessary. Both have shown some efficacy in reducing the risk of preterm birth in women with a short cervix. In certain cases, a transabdominal cerclage may be considered, especially for women who have failed a transvaginal cerclage in previous pregnancies.Success Rates and Long-Term Outcomes
Transvaginal cerclage has a high success rate in preventing preterm birth and miscarriage in women with cervical insufficiency. Studies have shown that the procedure significantly reduces the risk of preterm birth before 34 weeks of gestation. Long-term outcomes are generally positive, with many women going on to have successful full-term pregnancies.Consultation and Decision-Making
The decision to undergo transvaginal cerclage should be made after a thorough consultation with a healthcare provider. Discussing the risks, benefits, and alternatives helps in making an informed decision. It is crucial to consider the individual's medical history, current pregnancy status, and overall health before proceeding with the surgery.
