Cervical Cerclage

What Is Cervical Cerclage?

Cervical cerclage, also known as a cervical stitch, is a procedure done during pregnancy in which your doctor will sew your cervix closed. The cervix is a funnel-shaped tissue that opens during childbirth so the baby can move out of the uterus and through the vagina.

Your doctor will do it if they think your baby might arrive too early or that you could miscarry because your cervix is weak. You can have it done at a hospital or a surgical center. You’ll most likely go home the same day.

Why Is Cervical Cerclage Done?

When your body gets ready to give birth, the cervix starts to dilate, or widen. But if your cervix is weak or has other problems, it might open too soon. This can lead to premature delivery or a miscarriage.

Your cervix may be weak if:

  • You’ve had a cervical cerclage during a previous pregnancy, especially after the 14th week (emergent cerclage).
  • You have a short cervix (less than 25 millimeters long), are carrying one baby, and are less than 24 weeks along.
  • You’ve had a cone biopsy of the cervix or a loop electrical excision procedure (LEEP).
  • You have a history of second-trimester pregnancy loss with painless dilation of the cervix.
  • Your cervix starts to open in your second trimester with painless dilation of the cervix.
  • You’ve previously given birth before 34 weeks of pregnancy and had a short cervical length before 24 weeks of pregnancy.
  • Your cervix has injuries from having one or more abortions in the past.

When Is It Done?

If your doctor recommends a cervical stitch because you’ve had problems with a previous pregnancy, it should ideally be done 12 to 14 weeks into your pregnancy. If the procedure is done after this time, it’s called an emergent cerclage. If you’ve had an emergent cerclage, you have a greater chance of needing another cerclage if you get pregnant again. Otherwise, you can have the surgery up to 24 weeks. Past that date, a cervical stitch could cause the amniotic sac to rupture and make your baby come too soon.

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When Is It Not Recommended?

Even if your cervix starts to widen too early, a cervical stitch may not be right for you if you also have any of the following:

  • Preterm labor
  • Vaginal bleeding
  • An infection in your uterus
  • A fetal anomaly that makes it unlikely your baby will live
  • Your amniotic sac, sometimes called the bag of waters, leaks or breaks before 37 weeks of pregnancy.
  • Your amniotic sac bulges through the cervix (prolapsed fetal membrane).
  • You’re pregnant with two or more babies (high-order pregnancy).

Cervical Cerclage Preparation

Before your cerclage procedure, there are a few steps you’ll need to take to get ready.

  • A review of your medical history
  • Ultrasound: Your doctor may order an ultrasound image of your womb to check your baby’s health and growth.
  • Screening for infection: Your doctor may either take a swab of your cervical mucus or put a needle gently through your belly into your uterus to draw a sample of amniotic fluids (amniocentesis).
  • Antibiotics: If you have an infection, you may need antibiotics. If possible, you’ll need to finish the treatment before your cervical stitch.

During the Cervical Cerclage

Before they start, your doctor will give you medicine to numb pain. If they use regional anesthesia, also called a spinal or an epidural, they’ll take a needle and inject the drug into your back. You may instead get general anesthesia, which puts you to sleep so you don’t feel anything.

The surgery is done either through the vagina (transvaginal) or the belly (transabdominal):

Transvaginal: This is the most common way to do the procedure. Your doctor will use a tool called a speculum to hold your vagina open in order to reach the cervix. They’ll then stitch the cervix closed.

Transabdominal: You might need this surgery if you had a cervical stitch before and it didn’t work. You may also have it if your cervix is too short. Your doctor will make a small cut in your belly. They may need to pull your uterus up to reach your cervix and close it.

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After the Cervical Cerclage

Your doctor may do another ultrasound to check your baby. You may have symptoms for a few days after the surgery. These could include:

  • Blood spots on your underwear
  • Cramps
  • Pain when you pee

You can take acetaminophen for pain

If you had the surgery because you have a history of cerclage or if your cervix has already started to open, you might need to stay in the hospital for a while. You may need to visit your doctor every 1 to 2 weeks to check your cervix until your baby comes. Ask your doctor how much you can safely move and exercise and when you can have sex.

Before Delivery

Your doctor will take out the cervical stitches before you give birth. This is usually around 37 weeks of pregnancy. They’ll do it sooner if you go into labor.

If you deliver by cesarean section and hope to have more children, you may be able to keep the cervical stitches in place. But that could make it more difficult for you to get pregnant again. Talk to your doctor about it.

If you got the stitches through your belly, your doctor will most likely recommend a C-section when you’re 37 to 39 weeks pregnant. You can decide to have the stitches removed during your C-section.

Cervical Cerclage: Risks

As with any surgery, a cervical stitch could lead to problems that may include:

  • Vaginal bleeding
  • A tear in the cervix
  • Infection
  • Water breaking too early
  • Premature labor or birth
  • Miscarriage

Call your doctor if you see any fluid leaking from your vagina. This could mean that your water has broken too soon. Your doctor may decide to take out the cervical stitches early.

Cervical Cerclage Results

Doctors don’t all agree on how well cervical cerclage works. If you definitely have a weak cervix (cervical insufficiency), it will most likely lower your chances of a premature delivery. But progesterone shots may work as well.

How well cervical cerclage works depends a great deal on when you have it done. If it’s done in an emergency, when your cervix has already changed size or shape, it’s less likely to work.

WebMD Medical Reference Reviewed by Hansa D. Bhargava, MD on September 17, 2020

Sources

SOURCES:

Mayo Clinic: “Cervical Cerclage,” “Pelvic Exam.”

March of Dimes: “Ultrasound During Pregnancy.”

International Anesthesia Research Society: “Cervical Cerclage: Anesthesia Management.”

American Society of Regional Anesthesia and Pain Medicine: “Regional Anesthesia for Surgery.”

Cleveland Clinic: “Cervical Cerclage.”

American Journal of Obstetrics and Gynecology: “The role of cervical cerclage in obstetrical practice: can the patient who could benefit from this procedure be identified?” “Vaginal progesterone is as effective as cervical cerclage to prevent preterm birth in women with a singleton gestation, previous spontaneous preterm birth, and a short cervix: updated indirect comparison meta-analysis.”

American Pregnancy Association: “Cervical Cerclage.”

© 2020 WebMD, LLC. All rights reserved.

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