Cervical cerclage

Cervical cerclage

If a woman has a history of a short cervix, they can opt for a procedure called the Cervical Cerclage. This procedure either uses a suture or synthetic tape in order to reinforce woman’s cervix.

This is a procedure that can be done through the following organs:

  • Through the vagina: in this case, the procedure is called transvaginal cervical Cerclage.

  • Through the abdomen: In this case, the procedure is called transvaginal cervical Cerclage.

The reason for this procedure

When you are not pregnant, your cervix is firm and closed for a long time. However, as time passes and after sexual intercourse, you become pregnant, the cervix dilates and also opens up for the preparation of the child’s birth. However, if the cervix is short or incompetent, it might open up too soon. This tends to create issues like premature childbirth or pregnancy loss. To that end, the cervical Cerclage is a procedure that is most often recommended.

The reasons for this procedure also entail the following: 

  • The history of child loss during the second trimester

  • There might be a prior Cerclage because of painless cervical dilation. 

  • If painless cervical dilation is diagnosed during the second semester. 

  • The length of the cervix is short. 

When is this procedure not recommended?

There are times when this sort of procedure is not recommended for the women and the reasons are as follows:

  • If the vaginal bleeding is still active

  • If the preterm labor is active

  • If there is either a chance of or already there intrauterine infection

  • Rupture of the membrane prematurely

  • There is a chance that you might be having twins.

  • There is a fetal anomaly. There might be a case where the fetal is not able to live. 

How to prepare for this procedure?

  • Your doctor would first ultrasound you to check for your baby’s vital signs. This is also the process to make sure that the baby is healthy.

  • The doctor would then take a swab of your cervical secretions. 

  • An amniocentesis can also be performed. 

  • The samples are then checked for any kind of infection.

  • The cervix then checks for any sort of infection.

  • The process then begins

There is one thing to remember here is that the process of Cervical Cerclage happens after the 24th week of the pregnancy. If it is done any sooner than that, there might be a case where the amniotic sac ruptures. 

During the procedure

  • There will be speculum inserted into your vagina. This apparatus grasps your cervix. 

  • To guide this process, ultrasound will happen simultaneously. 

  • For the McDonald operation will take place and needles will be used to put stitches outside the cervix. This way 

  • For the Shirodkar operation, where your cervix will be pulled with forceps to the side walls of the vagina. Small incisions will be made next and a needle with a tape will be passed in order o close the cervix. The reposition of the vagina can also be done at this stage. 

  • For the transabdominal cervical Cerclage, an abdominal incision will be made and your doctor will then use a needle to place the tape around the narrow passage. This way, the lower part of the uterus will be connected to the cervix and then the cervix will be closed. 

After the procedure

1. Once the procedure is over with, the doctor will do an ultrasound again in order to check for the health of the baby. 

2. For the next few days, you can suffer from the following side effects: 

  • Spotting

  • Cramps

  • Painful urination

However, you will be provided with medications to manage the side effects. To that end, there is no need for you to worry. 

3. You will then be provided with tips for physical activity including sex during the period of pregnancy. 

Now, as for the removal of the Cerclage, it is going to be done during the 37th week of the pregnancy. It can also be done during the preterm pregnancy.

The risks of Cerclage

  • There can be inflammation of the fetal membranes

  • There can also be vaginal bleeding

  • There can also be a premature rupture of the membranes

  • The suture displacement can also happen.

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Dr. Madhu Goel is a well renowned senior gynaecologist and a senior consultant at Fortis La femme, New Delhi. She runs a private consultation in Goel’s surgery and Gynea centre and prior to being associated with Fortis; she was a consultant a Rockland Hospital.