Cervical cerclage is a medical procedure used to reduce the risks of miscarriage or premature birth. Although this technique is less common nowadays, it remains relevant in certain high-risk pregnancies. How does cervical cerclage work? Is it a painful procedure? What are the potential risks for pregnant women?
Cervical cerclage is a surgical procedure performed during pregnancy that involves placing a stitch around the cervix when there is a risk of it opening too easily. The goal is to provide mechanical support to the cervix and thereby reduce the risk of preterm delivery. It is usually done around the three-month mark of pregnancy and can be performed under local, regional, or general anesthesia.
The importance of cervical cerclage
During a normal pregnancy, the cervix remains fully closed, allowing the pregnancy to reach full term. Towards the end of pregnancy, the cervix starts to shorten and gradually soften in preparation for childbirth and delivery. Sometimes, the cervix may shorten and dilate too early, which can lead to late miscarriage or premature birth.
Different types of cervical cerclage
There are three types of cervical cerclage:
- Prophylactic cerclage: Early cerclage placed between 13 and 16 weeks, decided at the beginning of pregnancy, taking into account obstetric history.
- Therapeutic cerclage: Cervical cerclage between 16 and 24 weeks, decided upon detection of cervical changes during pregnancy.
- Late cerclage: Cervical cerclage beyond 24 weeks, often exceptional.
Different techniques for cervical cerclage placement
Cervical cerclage is a surgical technique offered in the management of high-risk pregnancies. Only a doctor is qualified to decide if this method is most suitable for a patient’s case. There are three main techniques that are used depending on the medical context.
- Transvaginal cervical cerclage: This is by far the most commonly performed method. It involves tying a non-absorbable suture around the cervix at its insertion in the vagina.
- Cervico-isthmic cerclage: This technique is used when the cervical length is very short, in cases of a history of conization (surgery of the cervix), or after the failure of a traditional cerclage. In this case, a non-absorbable band is placed in the supravaginal portion of the uterine body.
- Abdominal cerclage: This involves placing a band through an abdominal incision, known as laparotomy. It is offered after the failure of a vaginal cerclage and when vaginal access is difficult. This technique implies delivery by caesarean section.
The procedure is performed under local or general anesthesia and through the vaginal route. It is also necessary to follow the doctor’s prescriptions regarding lifestyle or dietary choices to avoid premature delivery.
Postoperative precautions and complications
Used for over 50 years, cervical cerclage is currently less commonly performed. In the case of a high-risk pregnancy, if the doctor chooses this method, they generally recommend:
- a rest before and after the intervention
- a hospital stay of at least 48 hours (the patient should enter the day before the surgery and leave the following day)
- complete rest for a few days after the intervention
- avoid taking baths
- avoid any sexual activity
It is quite normal to observe traces of blood a few days after cervical cerclage. The doctor may also prescribe a local antiseptic treatment. However, it is imperative to seek urgent medical attention in case of pain, discharge of fluid, fever, or persistent bleeding.
In 1 to 9% of cases, cervical cerclage can lead to rupture of the amniotic sac. This type of complication is more common in emergency cerclage cases compared to preventive interventions. The procedure can also cause infection of the uterus or amniotic sac.
