What Is Cervical Cerclage?

If you’re pregnant and your doctor thinks your baby might arrive too early or that you could miscarry because of a weak cervix, she may do something called a cervical cerclage. This surgery is also called a cervical stitch. It’s done to keep 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. You can have the procedure done at a hospital or a surgical center. Patients usually go home the same day.

Why Is It 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 doctor may suggest the procedure if:

  • You have a history of second-trimester pregnancy loss with painless dilation of the cervix
  • You’ve had a cervical cerclage during a previous pregnancy
  • Your cervix starts to open in your second trimester with painless dilation of the cervix
  • You’ve given birth before 34 weeks of pregnancy and you’ve had a short cervical length before 24 weeks of pregnancy

When Is It Done?

If your doctor recommends cervical stitch because you’ve had problems with a previous pregnancy, it should ideally be done 12 to 14 weeks into your pregnancy. Otherwise, you can have the surgery up to 24 weeks. Past that date, cervical stitch could cause the amniotic sac to rupture and make your baby come too soon.

When Is It Not Recommended?

Even if your cervix starts to widen too early, 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
  • Your amniotic sac, sometimes called the bag of waters, leaks or breaks before 37 weeks of pregnancy
  • Your amniotic sac bulges through the cervix

Cervical stitch is recommended only if you’re pregnant with one baby.

What to Expect Before the Procedure

Your doctor will get an ultrasound image of your womb to check your baby’s health and growth. She may also check for infections. She may either take a swab of your cervical mucus or put a needle gently through your belly into your uterus to draw sample amniotic fluids. If you have an infection, you may need antibiotics. If possible, you’ll need to finish the treatment before your cervical stitch.

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What to Expect During the Procedure

Before she starts, your doctor will give you medicine to numb pain. If she uses regional anesthesia, also called a spinal or an epidural, she will 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 either done 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. She’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. She may need to pull your uterus up to reach your cervix and close it.

After Surgery

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 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. She’ll do it sooner if you go into labor.

If you deliver by C-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.

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Complications

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.

WebMD Medical Reference Reviewed by Nivin Todd, MD on January 20, 2018

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.”

© 2018 WebMD, LLC. All rights reserved.

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