Cervical cerclage - Comprehensive Information on Cervical cerclage, Preparation and Risks involved during the test

Cervical cerclage

Cervical cerclage is a procedure that is used to treat cervical incompetence. It is also known as a cervical stitch. Cervical incompetence is a condition
when the cervix shortens or opens too early during pregnancy. Cervical incompetence also means that the cervix may be too weak, making it unable to
stay closed during pregnancy. The cervix can become weak due to earlier miscarriages during the second trimester, damage to the cervix that
occurred due to an early pregnancy termination, or an earlier cone biopsy procedure. This premature opening of the cervix may lead to miscarriages or
premature delivery, if it is not identified during the early stages of pregnancy.

The need for a cerclage is identified after an ultrasonography. The actual cervical cerclage procedure involves stitching a strong suture around the
cervix to tighten it and is normally recommended by a physician during the second trimester, which is the 12th to 14th week of pregnancy. Cervical
cerclage is a surgical procedure, and the patient is administered an anesthesia prior to it. A spinal anesthesia or epidural is the most commonly used
method, and in some cases, a general anesthesia is given to the patient. The two most commonly used techniques to perform the cerclage are the
McDonald and Shirodkar techniques. The McDonald is a temporary technique in which the suture is normally removed at around the 37th week of
pregnancy, whereas the Shirodkar technique is a permanent one. As the Shirodkar technique is permanent, a caesarean section will be required to
deliver the baby.

Preparing for the cervical cerclage

Preparing for the cervical cerclage involves a number of steps. A complete medical history of the patient is first taken, and then the patient is normally
asked to undergo a transvaginal ultrasound scan. The transvaginal ultrasound helps to identify the state of the cervix and whether the patient is ready
to undergo the cerclage. The patient is asked not to drink any water or consume any food for at least 10 to 12 hours before the procedure as this can
induce nausea and vomiting during anesthesia. The patient is also asked not to engage in a sexual intercourse, use tampons, or douche for at least 24
hours before the procedure. The patient is observed for a couple of hours after the procedure to ensure that they do not get into premature labor; they
are also asked to stay in bed for at least a week. It is normal for the patient to have light bleeding and cramps for a few days after the procedure.

Cervical cerclage risks

Although not very common, there are a few risks associated with a cervical cerclage. These are as follows:

• Risks associated with administering anesthesia

• Early rupture of membranes or premature “water break”
• Amniotic sac infection
• Preterm labor
• Cervical laceration or amputation
• Bladder injury
• Maternal hemorrhage
• Cervical dystocia
• Uterine rupture

Cervical cerclage removal

A cervical cerclage can be removed in the 37th week if the McDonald technique is used; however, some doctors recommend that the suture be
retained as it can also help with the next pregnancy.

Cervical cerclage is certainly a life saving procedure and is considered to be the most effective to treat cervical incompetence