Many concerns plague the minds of moms-to-be as they endure each trimester of their pregnancy. One of the biggest concerns, however, is the fear of premature birth. There are many recommendations to avoid this concerning experience from happening. But some women may need a little extra help staying full term due to the size of their cervix or an uncontrollable dilation.
Fortunately, there is a way to prevent premature birth. Known as a cervical cerclage, this medical procedure can help women with cervical issues prevent early labor from happening and ultimately keep their baby healthy.
What is a cervical cerclage?
Cervical cerclage, or cervical stitch, is a medical procedure performed during pregnancy when the cervix (the opening of the uterus) starts to dilate or widen before the expected due date. This premature opening of the cervix can lead to pregnancy loss or premature birth.
The surgery is also performed on women prone to cervical incompetence, such as a short cervix, or whose cervix can open prematurely during pregnancy. To keep the cervix from further dilating, it is reinforced with stitches or synthetic tape.
The earliest a cervical cerclage can occur is 12 to 14 weeks of gestation, with 24 weeks being the latest. Doctors do not recommend the procedure after 24 weeks due to the risk of puncturing the amniotic sac, which can induce premature birth.
Who is eligible for the procedure?
Healthcare providers may suggest a cerclage if a woman has a history of pregnancy loss in the second trimester related to painless cervical dilation in the absence of labor or placental abruption (history-indicated cervical cerclage).
Women who received a previous cerclage due to painless cervical dilation in the second trimester, those diagnosed with painless cervical dilation in the second trimester, and of course, expecting mothers with cervical incompetence may also be eligible for the surgery.
However, women who are experiencing the following concerns may not be eligible:
- Active vaginal bleeding
- Active preterm labor
- An intrauterine infection
- Preterm premature rupture of membranes
- Pregnancy with twins or more
- Fetal anomaly
- Prolapsed fetal membranes (amniotic sac is protruding through the opening of the cervix)
Risks of a Cervical Cerclage
The associated risks of the procedure include a bacterial infection causing inflammation of the fetal membranes, vaginal bleeding, a cervical tear (cervical laceration), suture displacement, and preterm premature membrane rupture. After a cerclage is placed, problematic indicators are contractions or cramping, lower abdominal or back pain, fever over 100° F, nausea and vomiting, a foul-smelling discharge, or water breaking or leaking.
How to Prepare for the Surgery
To prepare for a cerclage procedure, your physician may ask you to do an ultrasound to check your baby’s vitals and growth, as well as to rule out any serious birth defects. You may also be screened for infections through a swab test. Your doctor will take a swab of your cervical mucus or perform an amniocentesis. This procedure places a needle through the belly and into the uterus to draw a sample of amniotic fluid. If an infection is present, you’ll be prescribed antibiotics and may need to finish the medication before undergoing surgery.
What to Expect During the Surgery
Before the procedure begins, your doctor will provide medicine to numb the pain, such as an epidural injected into the back or general anesthesia that will put you to sleep. The surgery is performed in two ways: transvaginal (through the vagina) or transabdominal (through the belly).
- Transvaginal cerclage: The most common surgery method. A transvaginal cerclage is performed using a speculum to hold the vagina open, which allows your doctor to stitch the cervix closed.
- Transabdominal cerclage: More commonly used for women who’ve had a prior cervical stitch that didn’t take or whose cervix is too short. The transabdominal cerclage is completed by making a small cut in the stomach and potentially elevating your uterus to reach the cervix and tie it closed.
After the surgery is complete, your healthcare provider will perform another ultrasound to check your baby’s wellbeing. You may experience light spotting, cramps, and pain while urinating in the days following the procedure. But the side effects can be managed with acetaminophen (Tylenol) to ease any discomfort.
Things to Remember After Surgery
If you’ve undergone the surgery before, or if your cervix has started to open again, you’ll likely be required to stay in the hospital for some time. You may also need to visit your doctor every one to two weeks to check the status of your cervix until it’s time for your delivery.
Be sure to keep an eye on your symptoms. If they’ve worsened and you do not notice any improvements, contact your doctor immediately. You may need to be screened once again and have another ultrasound performed, if necessary.
Typically, around 37 weeks of pregnancy, your stitches will be removed in advance of giving birth. For transabdominal stitches, your doctor will likely recommend a cesarean section around the time that you are 37 to 39 weeks pregnant.
Consult your doctor if you have any questions or concerns about cervical cerclages. Your doctor can help you determine if it’s the best option for you and your baby.