What is Cervical Cerclage?
Cervical cerclage is a medical procedure aimed at preventing premature birth in pregnant women who are at risk due to cervical incompetence. Cervical incompetence refers to a condition where the cervix weakens and opens too early during pregnancy, potentially leading to miscarriage or preterm birth.
Cervical incompetence can occur due to various factors, including:
- Previous cervical surgery: Such as conization or dilation and curettage, which may weaken cervical tissue.
- Trauma: Injuries to the cervix can compromise its structural integrity.
- Congenital abnormalities: Some women may have anatomical issues that predispose them to cervical incompetence.
- Multiple pregnancies: Women carrying twins or more may be at higher risk.
Indications for Cervical Cerclage
Cervical cerclage is typically recommended for women who have:
- A history of second-trimester losses due to cervical incompetence.
- A prior preterm birth related to cervical shortening.
- Documented cervical shortening identified through ultrasound examinations during the current pregnancy.
The procedure is often discussed during the first or early second trimester of pregnancy.
Types of Cervical Cerclage
There are two main types of cervical cerclage:
Transvaginal Cerclage: This is the most common method, where the cerclage is placed through the vagina. The surgeon uses sutures to stitch the cervix closed, providing additional support.
Transabdominal Cerclage: This approach is less common and involves placing the cerclage through an abdominal incision. It is typically reserved for women with significant cervical incompetence who have had previous unsuccessful vaginal cerclage or those with anatomical abnormalities.
The Procedure
Cervical cerclage is usually performed in a hospital setting, often under local or general anesthesia. The steps of the procedure include:
Preparation: The patient is positioned comfortably, and the area is cleaned and sterilized.
Accessing the Cervix: Using a speculum, the healthcare provider examines the cervix to assess its condition.
Placing the Sutures: For a transvaginal cerclage, the provider inserts sutures around the cervix, creating a supportive stitch that helps keep it closed. In a transabdominal cerclage, the sutures are placed through an abdominal incision.
Post-Procedure Monitoring: After the procedure, the patient is monitored for any signs of complications, such as infection or bleeding.
Risks and Complications
While cervical cerclage is generally safe, it does carry some risks, including:
- Infection: There is a risk of infection at the site of the procedure.
- Bleeding: Some women may experience bleeding during or after the procedure.
- Premature Rupture of Membranes: In rare cases, the procedure can lead to the rupture of the amniotic sac, increasing the risk of preterm labor.
- Cervical Injury: The suturing process may inadvertently damage the cervix or surrounding tissues.
Post-Procedure Care
After cervical cerclage, patients are often advised to:
- Limit physical activity: It is generally recommended to avoid heavy lifting and strenuous activities.
- Monitor for symptoms: Women should be vigilant for signs of infection, such as fever, increased discharge, or pelvic pain.
- Regular follow-ups: Scheduled prenatal visits are essential to monitor the condition of the cervix and the pregnancy’s progress.
Removal of Cervical Cerclage
Cervical cerclage is usually removed between 36 to 38 weeks of pregnancy or when labor begins. In some cases, if the cervix remains incompetent, the cerclage may be removed earlier to allow for safe delivery.