Cervical Cerclage

What is cervical cerclage?

Cervical cerclage is a treatment to keep your cervix (neck of the womb) closed during pregnancy with a special stitch. This is usually recommended if you are at risk of a premature pregnancy or a late miscarriage due to incompetent (weakened) cervix. This procedure will protect the fetus inside of the uterus until it is safe for you to give birth.

Your cervix should close tightly and block off your uterus when you become pregnant. Your cervix will be placed under increased pressure as your baby grows. If you have a weak cervix, it may open without pain, causing your membranes to come out of the uterus and rupture (waters breaking). A weak cervix can lead to a late miscarriage (pregnancy ending between 12 and 24 weeks).

Why is cervical cerclage performed?

There are a number of reasons you may be recommended cervical cerclage during your pregnancy, including:

• A weak (incompetent) cervix. This may be due to past surgeries to remove (potentially cancerous) cervical tissue.
• Past miscarriages - due to damage to your cervix or from an abnormally shaped uterus (womb).
• Past miscarriages during the second trimester which indicate a weakened cervix.

It is important to discuss your medical history and past pregnancies or miscarriages with your doctor. They will be able to recommend a cervical cerclage procedure if they believe it will benefit you. This will normally be performed before increased pressure is placed on the cervix by the fetus around 12 to 14 weeks into your pregnancy.

Risks of cerival cerclage

You will only be recommended a cervical cerclage procedure if it is believed that the benefits will outweigh the risks. However, there are some risks associated with a cervical cerclage procedure, including:

• Infection
• Damage to the cervix
• Bleeding
• Premature rupture of membranes - meaning your "water breaks" before it should. The premature rupture of membranes can trigger preterm labour and premature birth.
• Cervical stenosis (narrowing of the cervix permanently)
• Scar tissue on the cervix
• Tearing of the cervix or uterus if labour starts while sutures (stitches) are still intact. Your cerclage can be removed early if you go into labour.

What happens before a cervical cerclage procedure?

Your specialist will go over your medical history and discuss any previous complications from pregnancies or surgeries you may have had on your cervix, before your procedure.

They will also examine your cervix before the procedure by placing a speculum inside your vagina. This is so they can see your cervix clearly, similarly to a routine Pap smear. They may also perform a transvaginal ultrasound. You will have to abstain from sex for a week before and after your procedure, as recommended by your specialist.

You will also be able to ask your specialist any questions, or raise any concerns prior to having your procedure. It is normal to feel nervous.

What happens during a cervical cerclage procedure?

• Cervical cerclage is usually performed under a local or spinal anaesthetic, taking between twenty minutes and half an hour. You will lie back on an examination table with your legs in "stirrups", similarly to a vaginal examination.
• Your obstetrician will clean your vagina with an antiseptic.
• Your specialist will stitch your cervix close with a strong synthetic tape.

Is a cervical cerclage painful?

You will likely experience some light cramping and bleeding/spotting for a few days after your procedure. You will be able to return to normal activities and have sex after around a week. You should avoid heavy lifting or intense exercise.

If you experience any pain, heavy bleeding, contractions, or you think you may be going into labour, let your specialist know straight away. Your stitches will typically be removed around 36 weeks into your pregnancy.

What happens after this procedure?

You will stay in the clinic for a couple of hours to ensure you don't have any complications. You will go home the same day as your treatment. You may also be given antibiotics to prevent infection.

You should rest for the remainder of the day, and not return to work. You should allow plenty of time for your stitches to heal (between 7 and 10 days), in which you should refrain from strenuous activities or sexual intercourse. You should also follow any advice given by your specialists and attend any follow-up appointments to monitor your pregnancy.