A cervical cerclage is a surgical procedure surgery in which the cervix, that is, the opening to the uterus is stitched closed in order to prevent a premature birth or a miscarriage. 10 percent of all pregnancies end in a premature delivery. The children born prematurely are more prone to health problems like respiratory diseases, infections, and difficulty in regulating body temperature. Preterm births are also responsible for 75 percent deaths in newborns and 85 percent long-term disabilities.
The cervix is usually closed tightly during the tenure of pregnancy and expands when the baby is ready to take birth. An incompetent cervix is vulnerable to dilate prematurely during the second trimester of pregnancy, which can lead to preterm delivery or a miscarriage, as the growing fetus puts too much strain on the cervix. A woman having an incompetent cervix is 3.3 times likely to give birth prematurely. This is the reason why a cervical cerclage is needed.
A doctor may recommend performing a cervical cerclage if there exist one or more of these risk factors: -
· Previous surgery or trauma to the cervix
· Hormonal influences
· A previous premature delivery
· Early ‘breaking of water’
· Abnormalities of the cervix or uterus
Diagnosis or Preparation
Diagnosis for an incompetent cervix is done by manual examination during a pelvic exam or examination using ultrasound technology. A study of medical history is also done for diagnosis. The symptoms that are used to decide the necessity of a cerclage are shortening of the cervix, dilation of the cervix, and 25 percent or more funnelling of the cervix.
· A complete medical history will be taken.
· Usually a transvaginal ultrasound is performed to assess the state of the cervix
· No food or drinks are allowed after the midnight of the day on which surgery is to be performed. This is done to avoid nausea or vomiting.
· Sexual intercourse must be avoided for 24 hours before the procedure. Also, refrain from using tampons and douches.
· An IV catheter will be placed to administer medication and fluids, before the procedure.
Methods of cervical cerclage
1. Shirodkar Cerclage Method: In this method, the doctor pulls the vaginal wall apart to pull the cervix towards him or her and makes an incision into it. Next, the doctor passes a needle with tape through the incision in order to tie the cervix. The stitches pass through the cervix wall so they are uncovered. This method often necessitates a C-section delivery.
2. McDonald Cerclage Method: The doctor, using a needle, places the stitches around the intravaginal segment of the cervix, i.e., the outside of the cervix. The stitches, upon reaching a full term, are removed.
3. Transvaginal Cerclage Method: If the cervix is too short for the performing of the above two methods and vaginal cerclage has failed, this method is used. It is most uncommon and permanent in nature. In this procedure, a tape is placed around the cervical passage to tie it. C-section delivery is required in these cases.
· You will be placed under observation to ensure that you do not show any sign of preterm labour.
· Antibiotics and medication may be prescribed to ease the pain and fight infections
· You will be advised to not engage in sexual intercourse and other physical activities for a few weeks after the surgery.
· For a few days of surgery, you may experience vaginal discharge, spotting, or cramps.
· The doctor will check the stitches and look for signs of preterm labour in the follow-up visits.
If you notice any of the symptoms like an infection with fever or chills, or excessive vaginal discharge, pain, or bleeding, or water break, or persistent vomiting or nausea, or contractions and cramps, you need to immediately talk to your doctor. You need to take a good care of yourself and avoid all mental and physical stress.