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Cerclage – Surgery for Cervical Insufficiency
Cerclage is a surgical procedure performed during pregnancy in which the cervix is stitched closed to help prevent premature birth.
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Cerclage is a surgical procedure performed during pregnancy in which the cervix is stitched closed to help prevent premature birth.
What is a Cerclage?
A cerclage (also known as a cervical cerclage or cervical stitch) is a surgical procedure carried out during pregnancy. A non-absorbable suture or tape is placed around the cervix to keep it closed and prevent it from opening too early. The primary goal is to reduce the risk of preterm birth or second-trimester pregnancy loss.
When is a Cerclage Recommended?
A cerclage is indicated when a woman has a condition known as cervical insufficiency (also called cervical incompetence), where the cervix weakens and begins to open prematurely without contractions. Common indications include:
- History of preterm birth or second-trimester pregnancy loss
- Ultrasound findings showing a shortened cervical length (below 25 mm)
- Visible dilation of the cervix or prolapse of the amniotic sac
- Congenital or acquired weakness of the cervix
How is the Procedure Performed?
The cerclage is typically performed under regional or general anaesthesia and takes only a few minutes. There are several techniques available:
Vaginal Cerclage (McDonald or Shirodkar)
The most common approach involves placing a purse-string suture around the cervix through the vagina. The McDonald technique is technically straightforward and widely used. The Shirodkar technique places the suture closer to the internal os and may be preferred in anatomically challenging cases.
Abdominal Cerclage
This approach involves placing the suture at the level of the internal os via an open abdominal incision or laparoscopically. It is reserved for cases where vaginal cerclage is not feasible or has previously failed.
When is the Cerclage Removed?
In most cases, the cerclage is removed around 36 to 37 weeks of gestation to allow for a vaginal delivery. Women who have undergone an abdominal cerclage will require delivery by caesarean section. If preterm labour or premature rupture of membranes occurs, the suture must be removed promptly.
Risks and Complications
As with any surgical procedure, cerclage carries certain risks:
- Premature contractions or rupture of membranes triggered by the suture
- Infection of the cervix or amniotic membranes
- Cervical injury or scarring
- Rarely, failure of the cerclage despite correct placement
The decision to perform a cerclage is always made on an individual basis, carefully weighing the potential benefits against the risks.
Aftercare and Recovery
Following the procedure, women are often advised to limit physical activity and rest. Depending on individual risk factors, hospital monitoring may be required. Regular ultrasound examinations are used to monitor cervical length and overall pregnancy progress.
References
- Royal College of Obstetricians and Gynaecologists (RCOG): Cervical Cerclage – Green-top Guideline No. 60, 2011.
- Berghella V. et al. - Cerclage for short cervix on ultrasound: meta-analysis of trials using individual patient-level data. Obstetrics and Gynecology, 2005.
- American College of Obstetricians and Gynecologists (ACOG): Practice Bulletin No. 142 – Cerclage for the Management of Cervical Insufficiency, 2014.
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