As your baby grows, he puts more pressure on the uterus, which may sometimes cause the cervix (the lower part of the uterus) to start dilating days or even weeks before the baby is ready for delivery, a problem often referred to as cervical insufficiency or an incompetent cervix. A procedure in which cervix is closed using stitches to avoid premature birth or pregnancy loss is called Cervical cerclage.
Typically, the stitches are removed at around week 37 of pregnancy.
Cerclage are mainly of three types:
- McDonald cerclage: In this type of cerclage a permanent suture is placed around the cervix. This is the most common form used by doctors nowadays.
- Shirodkar cerclage: Shirodkar cerclage is made higher than McDonald cerclage to firmly close the cervix. Small incisions are made in the cervical and vaginal tissues which keeps the cervix closed until full term. This is another form of transvaginal surgery option.
- Transabdominal cerclage: Having a congenitally short cervix, a previous cervical surgery or a severe injury may make it too difficult to perform a cerclage transvaginally. During such cases, a transabdominal process is performed by tying the cervix through an incision made in the mother’s abdomen
A doctor might recommend a cerclage be performed if a woman has one or more of the following risk factors:
- a previous preterm delivery
- previous trauma or surgery to the cervix
- early rupture of membranes (“breaking water”)
- hormonal influences
- abnormalities of the uterus or cervix
- exposure as a fetus to diethylstilbestrol (DES)
Cervical cerclage procedure is successful in 85% to 90% of cases. Diagnosis of cervical ineffectiveness is very difficult, if diagnosed cervical cerclage will be very effective.
An incompetent cervix can be diagnosed by proper examination or by checking medical history and/or by examination. Some symptoms of an incompetent cervix used to decide if a cerclage is necessary are: cervical dilation, shortening of the cervix and funneling of 25% or more. Side effects and complications may occur as per the way cervical stitch is done, which include following risks:
- Infection of the cervix or amniotic sac
- Vaginal bleeding
- Preterm premature rupture of the membranes (PPROM)
- Cervical laceration or a tear in your cervix
- A miscarriage
- Preterm labor and birth
- Increased chances of a c-section
After doing cerclage, the mother will be kept under observation for several hours inorder to prevent premature labor.The patient will then be allowed to return home, but will be instructed to remain in bed or avoid physical activity for two to three days. Consult your health care professional regularly so they can monitor the cervix and stitch and could find out the signs of premature birth
Cervical cerclage isn’t appropriate for everyone. It can cause serious side effects and doesn’t always prevent premature birth. Understand the risks of cervical cerclage and whether the procedure might benefit you and your baby.