03 Jan Cervical cerclage: A preterm delivery prevention procedure for pregnant mother with rapidly shortening or weak Cervix
Cervical cerclage is a procedure that reinforces the cervix by the stitching or tying of the cervical opening
1. This procedure is usually performed when a pregnant woman has an incompetent cervix (a short or weak cervix). This is also an option for women with a history of late miscarriage (second trimester) as it has been shown to possess a high success rate (85%-90%) in preventing late miscarriages and preterm deliveries (birth before the 37th week of pregnancy)
2. If you are pregnant and have either had multiple cervical surgeries or late miscarriages, then you should speak with your doctor about this procedure. If you do not have a doctor or would prefer a specialist, visit us at 67th Street OB/GYN- Total Women’s Health Care for a list of our OB/GYNs in Manhattan today. It is important that you do not delay as the earlier a cerclage is performed, the higher the rate of success.
Who should get a cervical cerclage?
As the cervical cerclage is a low-risk procedure, it is recommended for pregnant women suffering from a variety of conditions that can lead to preterm labor. Below are some of the reasons your doctor may recommend a cervical cerclage:
- Women with histories of second-trimester miscarriages.
- A previous delivery that occurred before the 34th-week pregnancy.
- Weak cervix
- Painless dilation of the cervix during the second trimester
- Shortening of the cervix before the 24th week of pregnancy
- Women who have had the loop electrical excision procedure (LEEP) or cone biopsy may require a cervical cerclage.
For women with these issues, the procedure should be performed between the 12th and 14th week of pregnancy. Moreover, an emergency cerclage can be performed up until the 24th week. After this period a cerclage is rarely used as a prevention technique for preterm delivery.
What are the risks of a cervical cerclage?
Although rare, there are risks to having this procedure done. Below are some of the risk associated with this procedure:
- Infection: There is always a risk of infection when any medical procedure is performed. Your doctor would likely give you a dosage of antibiotics to prevent this.
- Cervical Laceration: A tear in the cervix may occur as a result of the cerclage if labor occurs before the cerclage is removed4.
- Preterm Premature Rupture of Membranes (pPROM): This is when you the fluid in the amniotic sac leaks or the sac completely ruptures, i.e when your water breaks.
- Cervical Dystocia: This is a condition in which the cervix is unable to dilate properly during labor.
- Surgical Damage of the Cervix: This is when the cervix is accidentally damaged during surgery.
- Cervical Stenosis: This is a condition in which the cervix is permanently narrowed or closed.
- Blood Loss: Excessive blood loss after surgery.
This procedure is highly recommended by doctors as the benefits outweigh the risks. Furthermore, the occurrence of any of the complications mentioned above is rare, as such you would be strongly advised to consider this procedure if you are at high risk of preterm delivery due to an incompetent cervix.
How is a cervical cerclage done?
The entire procedure usually takes about an hour and patients are usually discharged within a few hours or kept overnight for observation. General or epidural anesthesia is given to the pregnant mother for pain control. Afterward a stitch that wraps a strong thread around the cervix is placed. This thread is then tightened to firmly close and hold the cervix in place4. This procedure is usually done through the vagina (transvaginal cervical cerclage) and on rare occasion through the abdomen (transvaginal cervical cerclage). If this procedure is done through the abdomen, then the C-section will be required.
It is important not to delay if you have concerns as a cerclage will is more effective when done early. For more information on cervical cerclages, consult with one of our obstetricians in Manhattan today.