Gynaecology

Cervical cerclage is a surgical procedure which is done to pregnant women to place stitches around the cervix to hold it close until the baby is ready to be delivered. This is done to prevent the cervix (the opening of the uterus) from opening before 37^th week of pregnancy to avoid miscarriage or preterm delivery. Successful rate of the procedure is about 90%.

The best time to place a cerclage is during 12^th to 14^th week of pregnancy. However, some women may need an emergent cerclage to be placed later than 14^th week of pregnancy. The procedure is rarely performed after 24^th week of pregnancy.

Who needs cerclage?

Cerclage is done to help to prevent miscarriage or preterm labour, especially for those with incompetent cervix. The cervix does not have the internal strength to maintain the closure of the cervical canal. As a result, it will allow the fetus to be expelled before labour starts. If you have the followings symptom, you may be advised to have a cerclage.

The cervix shortens or it opens too early which later lead to miscarriage or preterm delivery.
Abnormally shaped uterus or damaged cervix that is caused by previous trauma or injury.
Recurrence of second trimester pregnancy loss.

What happens during the procedure?

Before the procedure, doctor may perform a series of transvaginal scans for you to see and measure your cervix carefully.
You are advised to avoid sexual intercourse, douching, applying vaginal pessary or gel 24 hours before the procedure.
Fasting at least 6 hours before the procedure.
Just before the procedure, you will be given general or regional anaesthesia.
Doctor will use a speculum to hold your vagina apart.
Stitches are placed around the cervix to hold it firmly close. (see movie below)

What happens after the procedure?

You will need to be hospitalized for a few hours or overnight to be observed for the signs of premature contractions which may lead to delivery.
You will be given medications to prevent infections and preterm delivery.
You may experience light bleeding and mild cramping immediately after the procedure. Normally these will stop after a few days.
You are advised to have good rest and avoid unnecessary physical activities 2 to 3 days after the procedure.
Do not have sexual intercourse after the procedure.
The stitches will usually be removed at the 37^th week of your pregnancy. The removal procedure is similar to that of a pap smear, no anaesthesia is required. It may cause light bleeding.
Delivery may occur soon after that.

Warning signs

If you experience the followings after the procedure, please consult your doctor immediately. These signs indicate that the cerclage is fail or there is a need to deliver the baby early.

Contraction pain that comes and goes.
Vaginal bleeding can be blackage, red or in clot.
Fever.
Nausea or vomiting.
Leaking liquor due to rupture of the water bag.

What are the risks of cervical cerclage?

Cervical cerclage can be associated with the following problems which may require the baby to be delivered early.

Infections in the cervix and water bag.
Cervical stenosis. (cervix is narrowed or closed permanently)
Cervical injury due to labour forcing the fetus against the cerclage on the cervix and tear to the cervical stitches.
Premature rupture of membrane (PROM) followed by infection.
Preterm labour. Insertion of cervical cerclage may stimulate the onset of labour.