Cervical cerclage

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Diagram of a cervical cerclage procedure

Cervical cerclage is a surgical procedure used to prevent preterm birth in women who have a cervical insufficiency. This condition, also known as an incompetent cervix, occurs when the cervix begins to dilate and efface prematurely during pregnancy, potentially leading to miscarriage or preterm delivery.

Indications

Cervical cerclage is typically indicated for women with a history of second-trimester pregnancy losses or preterm births attributed to cervical insufficiency. It may also be considered in cases where cervical shortening is detected via ultrasound during pregnancy.

Procedure

The procedure involves placing a stitch around the cervix to reinforce it and prevent it from opening too early. There are several types of cervical cerclage, including:

• Transvaginal cerclage: The most common type, performed through the vagina.
• Transabdominal cerclage: Performed through an incision in the abdomen, usually when a transvaginal cerclage has failed or is not possible.

The procedure is usually performed under regional anesthesia and can be done on an outpatient basis.

Timing

Cervical cerclage is typically performed between 12 and 14 weeks of gestation, although it can be done later in pregnancy if necessary. The timing depends on the patient's medical history and the condition of the cervix.

Risks and Complications

While cervical cerclage is generally safe, it carries some risks, including:

• Infection
• Bleeding
• Preterm labor
• Rupture of membranes

Removal

The cerclage is usually removed around 37 weeks of gestation or earlier if labor begins. In some cases, particularly with transabdominal cerclage, the stitch may be left in place if a cesarean section is planned.

Prognosis

Cervical cerclage can significantly reduce the risk of preterm birth in women with cervical insufficiency. However, it is not effective in all cases, and close monitoring throughout the pregnancy is essential.

Related pages

• Preterm birth
• Cervical insufficiency
• Pregnancy
• Obstetrics