About Cervical Cerclage

Cervical cerclage is a surgical technique aimed at reinforcing the cervix to prevent premature dilation. The cervix plays a vital role in maintaining a pregnancy by staying closed until labor begins. In cases of cervical insufficiency, the cervix may begin to open too early, which heightens the risk of preterm birth or miscarriage. Cervical cerclage provides the necessary structural support to the cervix, helping to preserve its integrity throughout pregnancy.

Typically performed under spinal or general anesthesia, the procedure involves placing sutures (stitches) around the cervix. These stitches are usually removed around 37 weeks of gestation or earlier if there are indications of labor or other complications.

While cervical cerclage can significantly lower the risk of premature birth, it does come with potential risks, including infection, bleeding, premature rupture of membranes, and cervical irritation.

Types of Cervical Cerclage

Cervical cerclage can be categorized into several types:

1. Prophylactic or Elective Cerclage: This type is performed early in pregnancy, typically between 12 to 14 weeks, for women who have a history of cervical insufficiency but show no current signs of cervical changes.

2. Emergency or Rescue Cerclage: This procedure is conducted when signs of cervical changes, such as shortening or dilation, are observed later in pregnancy. While riskier, this cerclage can still help in preventing preterm birth.

3. Transabdominal Cerclage: This method is reserved for cases where traditional cerclage approaches are unfeasible or have previously failed. It involves placing a band around the cervix through an abdominal incision.

Procedure of Cervical Cerclage

Cervical cerclage is performed through the following steps:

1. Timing: The procedure is usually conducted between the 12th and 14th weeks of pregnancy but can be performed up to the 24th week in certain circumstances, depending on the individual’s medical history and assessment of cervical length.

2. Anesthesia: Cervical cerclage can be administered under general anesthesia, regional anesthesia (such as epidural or spinal anesthesia), or local anesthesia, depending on the preferences of both the patient and healthcare provider.

3. Surgical Technique: Several techniques may be employed during the procedure, including the McDonald or Shirodkar method. The McDonald technique involves placing a suture around the cervix and tightening it for support, while the Shirodkar technique entails a more extensive surgical approach where a small portion of the cervix is dissected to create a tunnel for the suture.

4. Post-Procedure Care: After the cerclage, patients are often advised to limit physical activity, avoid heavy lifting, and refrain from sexual intercourse to reduce the risk of complications. Regular prenatal check-ups and monitoring of cervical length will continue throughout the pregnancy.

5. Removal of Cerclage: In some instances, the cervical cerclage is removed as the pregnancy nears its end, either through a planned procedure or during labor. This allows the cervix to dilate naturally for childbirth.

Cervical Stitch Removal Procedure

Cervical stitch removal typically occurs in the later stages of pregnancy or when the risk of preterm labor has diminished. This quick and relatively painless procedure involves using a speculum to access the cervix, where the healthcare provider carefully cuts and removes the stitches placed during the cervical cerclage. Usually performed as an outpatient procedure, it lasts only a few minutes and is generally well-tolerated without the need for anesthesia. After removal, the cervix is monitored to ensure it remains closed, and additional precautions may be advised to prevent premature labor.