Cervical Cerclage

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The doctor recommends cervical cerclage in the following circumstances.

• The patient has a history of her water breaking too early. This is known as preterm premature rupture of the membranes (PPROM).

• The patient has a history of late miscarriages or premature deliveries and the doctor suspects that it’s due to a weak cervix.

• The patient has a damaged cervix. This could happen during the previous birth if the patient pushed before the cervix was dilated or if forceps were used incorrectly.

• The patient has had a previous “cone biopsy” or a “LEEP” procedure

• The cervix has been damaged during an abortion.

Before proceeding for cervical stitch, the medical history is reviewed which includes an examination of your uterus functioning and cervix. The surgical gynecologist then determines the best-suited procedure for the particular case. Given below is the list of surgery types, Have a look.

• Transabdominal Cerclage (TAC): This type of surgery is performed during the first or second trimester of pregnancy to treat the cervical incompetence. This is used in subsequent pregnancies, for patients desiring future pregnancies. Also, It is a permanent procedure.

• Transvaginal Cervicoisthmic Cerclage (TVCIC): This can be removed for a vaginal delivery. It is an alternative to the transabdominal technique. The fetal survival chances are 83% after the surgery.

• Transvaginal Cerclage (TVC): In this technique, the surgeon sews the cervix of a patient using a suture placed through the vagina. It is placed between the 13 or 14 weeks of pregnancy.

  This is more common and the stitch in the cervix is made by going through the vagina. Transabdominal Cervical Cerclage In some cases, the stitch is put in itch at the top of the cervix using keyhole surgery (laparoscopy).

In most cases, the procedure is done between 16 and 24 weeks of the pregnancy. Some women may need a cerclage placed later in pregnancy (up to 27 weeks and 6 days). This is known as an emergent cerclage or a rescue stitch and is done after changes such as opening or shortening of the cervix have already begun.

If an emergent cerclage is required during the current pregnancy, future pregnancies will probably also require a stitching process. This is something the patient needs to be aware of. When the pregnancy is at 36-37 weeks, the doctor will remove the stitch.

The patient may go into labor the very next day but it could even be days or weeks before she does. If the patient goes into labor before the stitch is removed, it is important for the doctor to be informed and the stitch to be removed before childbirth. And, when the stitch is abdominal, the birth is through a cesarean surgery and the cervical stitch is not removed at all in this case.

The best way to identify the need for this medical procedure is through regular ultrasounds through the vagina. This will help to monitor how the cervix is holding up and the doctor can recommend a cerclage if required. Post the procedure, the patient may experience some symptoms listed below

• Cramps
• Spotting or light bleeding
• Foul smelling vaginal discharge
• Light Fever 
• Nausea
• Vomiting

Although it is a relatively minor procedure, cervical cerclage does carry the following risks with it. Premature contractions The inability of the cervix to dilate normally in the course of labor Rupture of membranes, infection, and laceration if labor happens before the cerclage is removed.

Risks associated with general anesthesia include Vomiting and nausea, However, the risks are very minimal compared to the life-saving nature of the procedure. It is successful in 90 percent plus cases. Failure of the cerclage would result in the patient losing her baby. An emergency process is conducted at a later stage when the cervix is already opening has a much greater chance of failing.