Cervical cerclage is a procedure that is used to treat cervical incompetence. An incompetent cervix occurs when the cervix becomes too weak to sustain the pressure of pregnancy, opening slightly and putting the baby at risk. Cervical incompetence is one of the most common causes of miscarriage in the 2nd trimester.
Your gynecologist can perform cerclage to hold the cervix closed, which can support your pregnancy by delaying labor.
Cerclage is a surgical procedure performed through the vaginal canal. The surgeon uses a speculum to open the vagina, access the cervix, and stitch it shut to prevent early dilation.
There are a few different ways that cerclage can be performed. All of them serve to tighten and strengthen the cervix to keep it closed until the pregnancy is brought to term. Your gynecologist may:
- Place stitches around the outside of the cervix.
- Make a small incision in the cervix, and then thread a surgical tape through it to close it.
- Tie surgical tape around the outside of the cervix, and hold it in place with stitches
Amniotic Sac Protrusion
If cervical incompetence is not caught until later in the pregnancy, the amniotic sac may start to protrude through the cervix. This problem can be addressed in one of two ways:
- A catheter (narrow tube) is introduced into the cervix, and then a small balloon at the end of the catheter is inflated to support the amniotic sac.
- A catheter is inserted through the urethra to fill the bladder with liquid. The pressure from the bladder can then nudge the amniotic sac back through the cervix.
Once the amniotic sac is back in place, we can stitch up the cervix.
Removal of Cervical Cerclage
The stitches must be taken out prior to the beginning of labor. This will not cause labor to start. However, if you go into labor early without having the stitches removed, this is a medical emergency and they must be removed immediately. In some scenarios, the baby must be delivered via Cesarean section.
Cervical Cerclage Risks
As with any surgery, there are some risks to performing cervical cerclage. These risks are rare and your medical team will take every precaution to ensure a safe procedure. Some risks include:
- Damage to the cervix
- Hemorrhaging (blood loss)
- Preterm labor
- Preterm premature rupture of membranes (pPROM) – this means the water breaks much too early
- Cervical stenosis (the cervix narrows or closes permanently)
- Tearing in the cervix or uterine tissue, if you go into labor with the stitches still in place
If you have reason to believe you are at risk for cervical incompetence, it’s important that you talk to your gynecologist about your concerns as soon as you can. It’s better to catch this issue early so that the necessary steps can be taken to reinforce your cervix before the baby gets too big, and before the amniotic sac forces itself through. Early treatment with cerclage can significantly reduce your chances of pre-term labor and miscarriage.