Cerclage

Def : procedure used to temporarily stitch the cervix closed in pregnant

women with a history of miscarriage or premature
Pemasangan sirklase adalah terapi pilihan untuk pencegahan kelahiran prematur pada
wanita dengan insufisiensi atau inkompetensi serviks. Penatalaksanaan inkompetensi serviks
adalah dengan cara bedah yaitu penguatan serviks yang lemah dengan jahitan yang disebut
sirklase. Perdarahan, kontraksi uterus, atau ruptur membran biasanya merupakan kontraindikasi
untuk pembedahan. Terdapat beberapa tehnik sirklase yang pernah dilakukan seperti
McDonalds dan modifikasi Shirodkar. Waktu terbaik untuk prosedur sirklase serviks adalah
pada bulan ketiga (12-14 minggu) kehamilan. Namun, beberapa wanita mungkin perlu
dipasangkan sirklase darurat pada kehamilan lanjut jika terjadi perubahan seperti pembukaan
atau pemendekan serviks. Jika sudah ada riwayat pemasangan sirklase darurat, pada kehamilan
selanjutnya juga wanita ini akan memerlukan pemasangan sirklase pada serviksnya.

1. Jenis Cerclage

A McDonald cerclage, described in 1957 is the most common, and is essentially a
pursestring stitch used to cinch the cervix shut; the cervix stitching involves a band of
suture at the upper part of the cervix while the lower part has already started to efface.
This cerclage is usually placed between 12 weeks and 14 weeks of pregnancy. The
stitch is generally removed around the 37th week of gestation.


A Shirodkar cerclage is very similar, but the sutures pass through the walls of the cervix so
they're not exposed. This type of cerclage is less common and technically more difficult
than a McDonald, and is thought (though not proven) to reduce the risk of infection. The
Shirodkar procedure sometimes involves a permanent stitch around the cervix which
will not be removed and therefore a Caesarean section will be necessary to deliver the
baby. The Shirodkar technique was first described by V. N. Shirodkar in Bombay in
1955. In 1963, Shirodkar traveled to NYC to perform the procedure at the New York
Hospital of Special Surgery; the procedure was successful, and the baby lived to
adulthood.
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An abdominal cerclage, the least common type, is permanent and involves stitching at the
very top of the cervix, inside the abdomen. This is usually only done if the cervix is too
short to attempt a standard cerclage, or if a vaginal cerclage has failed or is not
possible. However, a few doctors (namely Arthur Haney at the University of Chicago
and George Davis at the University of Medicine and Dentistry of New Jersey) are
pushing for the transabdominal cerclage to replace vaginal cerclages, due to perceived
better outcomes and more pregnancies carried to term.

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2. Komplikasi Cerclage
While cerclage is generally a safe procedure, there are a number of potential
complications that may arise during or after surgery. These include:

risks associated with regional or general anesthesia
premature labor
premature rupture of membranes
infection of the cervix
infection of the amniotic sac (chorioamnionitis)
cervical rupture (may occur if the stitch is not removed before onset of labor)
injury to the cervix or bladder
bleeding
Cervical Dystocia with failure to dilate requiring Cesarean Section
displacement of the cervix

3. Aftercare
After the cerclage has been placed, the patient will be observed for at least several
hours (sometimes overnight) to ensure that she does not go into premature labor. The
patient will then be allowed to return home, but will be instructed to remain in bed or
avoid physical activity (to include coitus) for two to three days, or up to two weeks.
Follow-up appointments will usually take place so that her doctor can monitor the cervix
and stitch and watch for signs of premature labor.
Kelainan Anatomi Uterus