CERVICAL CERCLAGE

Cervical cerclage :

Cervical cerclage is a procedure in which stitches are used to close the cervix during pregnancy to help prevent pregnancy loss or premature birth. The cervix is the lower part of the uterus that opens to the vagina.

Cervical cerclage can be done through the vagina (transvaginal cervical cerclage) or, less commonly, through the abdomen (transabdominal cervical cerclage). Typically, the stitches are removed at around week 37 of pregnancy.

Your health care provider might recommend cervical cerclage if your cervix is at risk of opening before your baby is ready to be born or, in some cases, if your cervix begins to open too early. However, cervical cerclage isn't appropriate for everyone. It can cause serious side effects and doesn't always prevent premature birth. Understand the risks of cervical cerclage and whether the procedure might benefit you and your baby.

Why it's done ?

Before pregnancy, the cervix is closed and rigid. During pregnancy, the cervix gradually softens, decreases in length (effaces) and opens (dilates) in preparation for birth. If you have an incompetent or weak cervix, however, your cervix might begin to open too soon. As a result, you could experience pregnancy loss or give birth prematurely.

Your health care provider might recommend cervical cerclage during pregnancy to prevent premature birth if you have:

  • A history of one or more second trimester pregnancy losses related to painless cervical dilation and in the absence of labor or placental abruption (history-indicated cervical cerclage).
  • Prior cerclage due to painless cervical dilation in the second trimester.
  • Upon physical exam, painless cervical dilation diagnosed during the second trimester.
  • A singleton pregnancy, a prior spontaneous premature birth at less than 34 weeks, and, upon ultrasound exam, a short cervical length (less than 25 millimeters) before 24 weeks of gestation.

Cervical cerclage isn't appropriate for everyone at risk of premature birth. Your health care provider might discourage cervical cerclage if you have:

  • Vaginal bleeding.
  • Preterm labor.
  • An intrauterine infection.
  • Preterm premature rupture of membranes — when the fluid-filled membrane that surrounds and cushions the baby during pregnancy (amniotic sac) leaks or breaks before week 37 of pregnancy.
  • A multiple pregnancyg.
  • A fetal anomaly incompatible with life.
  • Prolapsed fetal membranes — a condition in which the amniotic sac protrudes through the opening of the cervix.

Risks :

Risks associated with cervical cerclage include:

  • Infection
  • Vaginal bleeding
  • A tear in the cervix (cervical laceration)
  • Prolapse of the fetal membranes into the vagina
  • Preterm premature rupture of the membranes — when the fluid-filled membrane that surrounds and cushions the baby during pregnancy (amniotic sac) leaks or breaks before week 37 of pregnancy
  • Preterm labor and premature birth
  • Miscarriage

Keep in mind that if you have cervical dilation in the second trimester, it's possible that you might experience these problems even if you don't have cervical cerclage.

After receiving a cervical cerclage, contact your health care provider immediately if you have leakage of fluid from your vagina, a sign of preterm premature rupture of membranes. Your health care provider might recommend removing the cervical cerclage early if you have preterm premature rupture of membranes and a uterine infection, depending on your stage of pregnancy.

How you prepare ?

Before cervical cerclage, your health care provider will do an ultrasound to check your baby's vital signs and rule out any major birth defects. Your health care provider might take a swab of your cervical secretions or do amniocentesis — a procedure in which a sample of amniotic fluid is removed from the uterus — to check for infection. If you have an infection that requires antibiotics, you'll complete treatment before the cerclage is done — if possible.

Ideally, a history-indicated cervical cerclage is done between weeks 12 and 14 of pregnancy. However, cervical cerclage can be done up until week 24 of pregnancy if a pelvic exam or ultrasound shows that your cervix is beginning to open. Cervical cerclage is typically avoided after week 24 of pregnancy due to the risk of rupturing the amniotic sac and triggering premature birth. In some cases, cervical cerclage can be done before pregnancy.

If you have prolapsed fetal membranes — a condition in which the amniotic sac protrudes through the opening of the cervix — and your health care provider recommends cervical cerclage, he or she will treat the condition before doing the procedure.