Introduction

Cervicalcerclage is a medical procedure used to prevent preterm birth in women with aweakened or incompetent cervix. This condition, known as cervicalinsufficiency, can lead to premature labor, miscarriage, or pregnancy loss. Theprocedure involves stitching the cervix closed to provide additional supportuntil the baby reaches a viable gestational age.

This blogexplores cervical cerclage in detail, including its indications, types, risks,benefits, recovery process, and preventive measures to ensure a healthypregnancy.

Understanding Cervical Insufficiency

Thecervix plays a crucial role in pregnancy by remaining closed and firm untillabor begins. In some cases, however, the cervix may start dilating too earlydue to weakness, increasing the risk of pregnancy complications. Factorscontributing to cervical insufficiency include:

• Previous Pregnancy Loss: Women with a history of second-trimester miscarriages may have cervical incompetence.
• Cervical Trauma: Prior surgeries, such as cone biopsy or dilation and curettage (D&C), can weaken the cervix.
• Congenital Conditions: Some women are born with a structurally weak cervix.
• Multiple Pregnancies: Carrying twins or triplets may put excessive pressure on the cervix.

When is Cervical Cerclage Recommended?

Doctorsmay recommend cervical cerclage under the following circumstances:

1. History of Preterm Birth or Miscarriage: Women with multiple pregnancy losses due to cervical incompetence.
2. Short Cervix: If ultrasound scans indicate a short cervix (less than 25 mm) before 24 weeks of pregnancy.
3. Cervical Changes in Current Pregnancy: Early dilation detected through pelvic examinations.

Types of Cervical Cerclage

There aredifferent types of cervical cerclage, and the choice depends on the patient’smedical history and specific condition.

1. Transvaginal Cerclage (TVC)

• The most common type, performed through the vagina.
• A strong stitch is placed around the cervix to keep it closed.
• Usually performed between 12 to 16 weeks of pregnancy.
• Removed around 36-37 weeks when labor is expected.

2. Transabdominal Cerclage (TAC)

• A less common procedure for women with extreme cervical insufficiency.
• Involves placing a stitch at the top of the cervix through an abdominal incision.
• Performed before pregnancy or in early pregnancy.
• Unlike TVC, the stitch is not removed, requiring a cesarean section for delivery.

The Cervical Cerclage Procedure

Preparation for the Surgery

Beforethe procedure, the doctor may perform:

• Ultrasound Scan: To confirm pregnancy viability and check for infections.
• Pelvic Examination: To assess cervical dilation and length.
• Fetal Monitoring: To ensure the baby is healthy.
• Antibiotics and Medications: Given to prevent infections and reduce uterine contractions.

How is the Procedure Done?

• The procedure is usually performed under spinal, epidural, or general anesthesia.
• The surgeon stitches the cervix shut using strong sutures.
• It typically takes 30 to 60 minutes, and most patients go home the same day.

Risks and Complications of Cervical Cerclage

Like anymedical procedure, cervical cerclage carries certain risks, including:

• Infection: May lead to premature labor.
• Preterm Contractions: Can cause early labor in some cases.
• Cervical Tearing: Rare but possible if labor starts before stitch removal.
• Bleeding or Discomfort: Mild spotting and cramping are common after the procedure.

Recovery and Aftercare

Post-Procedure Care

• Rest for a Few Days: Avoid heavy lifting and strenuous activities.
• Pelvic Rest: No intercourse for at least a few weeks.
• Regular Check-ups: Frequent ultrasounds to monitor cervical length.
• Watch for Warning Signs: Seek medical attention for severe pain, fever, or contractions.

When is the Stitch Removed?

• Usually between 36-37 weeks to allow normal labor.
• Immediate removal may be necessary in case of preterm labor, infections, or rupture of membranes.

Benefits of Cervical Cerclage

• Reduces Risk of Preterm Birth: Provides support to the cervix, allowing a full-term pregnancy.
• Improves Fetal Survival Rates: Helps prevent second-trimester pregnancy loss.
• Gives Peace of Mind: Provides reassurance to women with a history of pregnancy complications.

Preventing Cervical Insufficiency

Whilesome risk factors cannot be controlled, the following measures can help maintaina healthy pregnancy:

• Early Prenatal Care: Regular monitoring of cervical length.
• Healthy Lifestyle: Proper nutrition, hydration, and avoiding smoking.
• Managing Chronic Conditions: Treating infections and hormonal imbalances.
• Medical Consultation: If you have a history of preterm birth, discuss preventive options with your doctor.

Conclusion

Cervicalcerclage is a valuable intervention for women at risk of preterm birth due tocervical insufficiency. While the procedure carries some risks, it significantlyimproves the chances of carrying a pregnancy to full term. If you haveexperienced pregnancy loss or have been diagnosed with cervical incompetence,consult your doctor to determine if cervical cerclage is the right option foryou.

Bystaying informed and proactive, expecting mothers can increase their chances ofa successful pregnancy and ensure the best possible outcome for their baby.