What is cervical cerclage?

Cervical cerclage (say "SER-vuh-kul ser-KLAZH") is a procedure that helps keep the cervix from opening too soon before delivery.

The cervix is the lower part of the uterus. It leads to the vagina. During pregnancy, it is tightly closed to protect the baby. Normally, it doesn't open until the baby is ready to be born. Most of the time, this happens at 37 to 42 weeks. But sometimes it opens too early.

In cervical cerclage, the doctor sews the cervix shut early in the pregnancy. The stitches are removed in time for the baby to be born.

You may get medicine that makes you unconscious. Or you may get medicine that makes the cervix numb. The procedure will take less than an hour. You may go home the same day.

This procedure can help some high-risk pregnancies last longer. But it also has risks. It can cause infection or miscarriage.

Activity

• Rest when you feel tired.
• Ask your doctor when it is okay for you to have sex.

Medicines

• Be safe with medicines. Read and follow all instructions on the label.
• If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
• Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions about taking any new medicines.

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

Cerclage can help some high-risk pregnancies last longer. For people who have had a preterm birth because the cervix did not stay closed, cervical cerclage may help prevent another preterm birth.

Procedures can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for your procedure.

Preparing for the procedure

• Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
• Understand exactly what procedure is planned, along with the risks, benefits, and other options.
• If you take a medicine that prevents blood clots, your doctor may tell you to stop taking it before your procedure. Or your doctor may tell you to keep taking it. (These medicines include aspirin and other blood thinners.) Make sure that you understand exactly what your doctor wants you to do.
• Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your procedure. Your doctor will tell you if you should stop taking any of them before the procedure and how soon to do it.
• Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.

Problems from cervical cerclage are rare. They include:

• Infection.
• Damage to the cervix during the procedure.
• Excessive blood loss.
• Preterm prelabor rupture of membranes (pPROM). This means your water breaks long before it should.
• Preterm labor.
• Permanent narrowing or closure of the cervix (cervical stenosis).
• Tearing of the cervix or uterus if labor progresses with the stitches still in place.

How long it takes to recover depends on the type of cerclage procedure you had. Your doctor can give you an idea of what to expect. You may get antibiotics for infection.

Cervical cerclage (say "SER-vuh-kul ser-KLAZH") is a procedure that helps keep your cervix from opening too soon. Your doctor has sewn your cervix shut to help prevent preterm labor.

For the next few days, you may have:

• Cramping.
• Spotting.
• Pain when you urinate.

Your doctor may give you instructions on when you can do your normal activities again, such as driving and going back to work.

Your doctor will usually remove the stitches from your cervix at 36 to 38 weeks, or if you go into preterm labor or show signs of infection. If you are planning to have a C-section, the stitches may be left in until you have the C-section.

Cervical cerclage is done using either general anesthesia or regional anesthesia (such as spinal injection). Usually cerclage is done through the vagina. A tool called a speculum is placed in the vagina. It opens the vagina a little bit. This lets your doctor see the cervix and inside the vagina. The procedure 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 cervical insufficiency is diagnosed later in pregnancy, the amniotic sac may start to push through the cervix. This may be treated in many different ways. One way is to insert a thin tube (catheter) through the cervix, and 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. Then the cervix can be stitched shut.

• Follow the instructions exactly about when to stop eating and drinking. If you don't, your procedure may be canceled. If your doctor told you to take your medicines on the day of the procedure, take them with only a sip of water.
• Take a bath or shower before you come in for your procedure. Do not apply lotions, perfumes, deodorants, or nail polish.
• Take off all jewelry and piercings. And take out contact lenses, if you wear them.

At the hospital or surgery center

• Bring a picture ID.
• You will be kept comfortable and safe by your anesthesia provider. The anesthesia may make you sleep. Or it may just numb the area being worked on.
• The procedure will take less than an hour.

Cervical cerclage may be done if you have cervical insufficiency or have a history of cervical insufficiency. This means that the cervix starts to open too early in pregnancy. You may have a history of cervical insufficiency if you:

• Had a previous pregnancy loss in the second trimester or an early delivery that occurred with few or no contractions. This is a clue that your cervix may not stay closed during pregnancy.
• Have a short cervix and have a history of early delivery.