Emergency cerclage is typically indicated when a woman presents with signs of cervical incompetence, such as:
- Cervical dilation and effacement before 24 weeks of gestation without contractions. - A history of second-trimester pregnancy losses associated with painless cervical dilation. - Evidence of a short cervix (How is the Procedure Performed? The procedure usually takes place in a hospital setting under anesthesia. The steps include:
1. Preparation: The patient is placed in a dorsal lithotomy position, and the vaginal area is cleaned. 2. Anesthesia: Regional anesthesia (such as a spinal block) or general anesthesia is administered. 3. Placement of Stitches: Using a speculum, the surgeon visualizes the cervix and places a strong suture around it, usually in a purse-string fashion. The most common techniques are the McDonald or Shirodkar methods. 4. Post-Operative Care: After the procedure, the patient is monitored for contractions, bleeding, or signs of infection. Bed rest may be recommended for a short period.
