Cervical cerclage is the placement of stitches in the
cervix to hold it closed. In select cases, this
procedure is used to keep a weak cervix (incompetent cervix) from opening early. When a cervix opens early, it may cause
preterm labor and delivery. If you have an incompetent
cervix, your doctor may recommend cervical cerclage.
cerclage involves stitching shut the cervix, which is the outlet of the uterus.
Cerclage can be done preventively at 12 to 14 weeks before the cervix thins
out, or as an emergency measure after the cervix has thinned. It is rarely used
after 24 weeks.
Cerclage is performed using either
general anesthesia or regional anesthesia (such as
spinal injection). Usually cerclage is done through the vagina. A speculum, an
instrument with paddles shaped like spoons, is inserted into the pregnant
woman's vagina to spread the vaginal walls apart for the surgery. The surgery
can be done in different ways:
- Stitches can be placed around the outside of
- A special tape can be tied around the cervix and
stitched in place.
- A small incision can be made in the cervix. A
special tape is then tied through the cervix to close it.
If an incompetent cervix is diagnosed later in pregnancy,
amniotic sac may begin to protrude through her cervix.
This may be treated by inserting a thin tube (catheter) through the cervix,
then inflating a bulb at the end of the catheter. Another technique involves
filling the bladder with liquid using a catheter inserted through the
urethra. The full bladder helps to push the amniotic
sac back up into the pelvis, and the cervix can then be stitched shut.
What To Expect After Surgery
The time required for recovery depends
on the type of cerclage procedure done. Your health professional can give you
an idea of what to expect.
be given after cerclage to prevent infection.
Why It Is Done
Cervical cerclage may be done when a
- Had a miscarriage
because of an abnormally shaped uterus or damage to the cervix. A damaged
cervix may not remain closed during pregnancy.
- Had a previous
second-trimester pregnancy loss or a delivery that occurred with few or no
contractions. This suggests that her cervix may not remain closed during
How Well It Works
Success of the cervical cerclage
procedure is defined as a pregnancy that lasts until term or close to term.
Cerclage has helped some high-risk pregnancies last longer, but
it also has risks-it can cause infection or miscarriage. For women who have had
a preterm birth because the cervix did not stay closed, cervical cerclage may
prevent another preterm birth.1
The risks of cervical cerclage are rare but can
- Damage to the cervix
- Excessive blood loss.
Preterm premature rupture of membranes (pPROM).
- Permanent narrowing or closure of the cervix (cervical
- Tearing of the cervix or uterus if labor progresses with
the stitches still in place.
What To Think About
- Is not used when a pregnant woman has vaginal
bleeding or uterine contractions or if her membranes have ruptured
- Requires that stitches be taken out of the cervix before
labor begins. Sometimes this is necessary on an emergency basis when labor
- May require a
cesarean section for delivery of the baby.
If you have a cervical cerclage in place, talk to your
doctor about whether you can have intercourse.
Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.
Haas DM (2010). Preterm birth, search date June 2009.
Online version of BMJ Clinical Evidence:
Primary Medical Reviewer
||Sarah Marshall, MD - Family Medicine
Specialist Medical Reviewer
||William Gilbert, MD - Maternal and Fetal Medicine
||January 10, 2011