Cervical cerclage to prevent preterm delivery

Surgery Overview

Cervical cerclage is the placement of stitches in the cervix to hold it closed. In select cases, this procedure is used to keep a weak cervix (incompetent cervix) from opening early. Sometimes, cervical cerclage prevents the cervix from opening before the 37th week of pregnancy and triggering preterm labour and delivery. If you have an incompetent cervix, your doctor may recommend cervical cerclage.

Cervical cerclage involves stitching shut the cervix, which is the outlet of the uterus. Cerclage can be done preventively at 12 to 14 weeks before the cervix thins out, or as an emergency measure after the cervix has thinned. It is rarely used after 24 weeks.

Cerclage is performed using either general anesthesia or regional anesthesia (such as spinal injection). Usually cerclage is done through the vagina. A speculum, an instrument with spoon-like paddles, is inserted into the pregnant woman's vagina to spread the vaginal walls apart for the surgery. The surgery can be done in different ways:

• Stitches can be placed around the outside of the cervix.
• A special tape can be tied around the cervix and stitched in place.
• A small incision can be made in the cervix. A special tape is then tied through the cervix to close it.

If an incompetent cervix is diagnosed later in pregnancy, the woman's amniotic sac may begin to protrude through her cervix. This may be treated by inserting a thin tube (catheter) through the cervix, then inflating a bulb at the end of the catheter. Another technique involves filling the bladder with liquid using a catheter inserted through the urethra. The full bladder helps to push the amniotic sac back up into the pelvis, and the cervix can then be stitched shut.

What To Expect After Surgery

The time required for recovery depends on the type of cerclage procedure done. Your health professional can give you an idea of what to expect.

Antibiotics may be given after cerclage, to prevent infection.

Why It Is Done

Cervical cerclage may be done when a woman has:

• An incompetent cervix.
• Had a miscarriage because of an abnormally shaped uterus or damage to the cervix.
• A previous second-trimester pregnancy loss or a delivery that occurred with few or no contractions. This suggests that her cervix may not remain closed during pregnancy.

How Well It Works

Success of the cervical cerclage procedure is defined as a pregnancy that lasts until term or close to term.

Cerclage has helped some high-risk pregnancies last longer, but it also has risks—it can cause infection or miscarriage. Studies suggest that cerclage makes twin pregnancies more likely to deliver early. Experts do not yet know when cerclage is most likely to work and when it isn't.¹

Risks

The risks of cervical cerclage are rare but can include:

• Infection.
• Damage to the cervix during surgery.
• Excessive blood loss.
• Preterm premature rupture of membranes (pPROM).
• Preterm labour.
• Permanent narrowing or closure of the cervix (cervical stenosis).
• Tearing of the cervix or uterus if labour progresses with the stitches still in place.

What To Think About

Surgical cerclage:

• Is not used when a pregnant woman has vaginal bleeding or uterine contractions or if her membranes have ruptured early.
• Requires that stitches be taken out of the cervix before labour begins. Sometimes this is necessary on an emergency basis when labour starts suddenly.
• May require a caesarean section for delivery of the baby.

If you have a cervical cerclage in place, talk to your doctor about whether you can have intercourse.

Complete the surgery information form (PDF)(What is a PDF document?) to help you prepare for this surgery.

Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: April 10, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Gregory A L Davies, MD, FRCSC, FACOG - Maternal-Fetal Medicine William Gilbert, MD - Perinatology
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