An incompetent cervix occurs when the cervix becomes too weak to sustain the pressure of pregnancy. The cervix opens slightly, putting you at risk for preterm labor. Cervical incompetence is one of the most common causes of miscarriage in the 2nd trimester.
Cerclage is a surgical procedure to help hold the cervix closed, delaying labor. The surgeon will use a speculum to open the vagina, access the cervix, and stitch it shut. This prevents early dilation and promotes a full-term delivery.
There are a few different ways to perform cerclage. All of them serve to tighten and strengthen the cervix, keeping 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 it through with surgical tape 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 protrude through the cervix. This problem can be addressed in one of two ways:
- A catheter (narrow tube) with a small balloon is introduced into the cervix. The balloon is then 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, with the stitches still in place, this is a medical emergency. They must be removed immediately. In some cases, the baby must be delivered via C-section.
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 of the cervix or uterine tissue, upon entering labor with the stitches still in place
If you believe you are at risk for cervical incompetence, bring it up with your gynecologist as soon as you can. It’s better to catch this issue early on, so that steps can be taken to reinforce your cervix before the baby gets too big, and before the amniotic sac is forced through. Early treatment with cerclage can significantly reduce your chances of pre-term labor and miscarriage.